Healthcare Provider Details

I. General information

NPI: 1902145584
Provider Name (Legal Business Name): ALISON URBANK PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2013
Last Update Date: 02/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 BETHANY
LAGUNA NIGUEL CA
92677-2931
US

IV. Provider business mailing address

18 BETHANY
LAGUNA NIGUEL CA
92677-2931
US

V. Phone/Fax

Practice location:
  • Phone: 949-636-5459
  • Fax:
Mailing address:
  • Phone: 949-636-5459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY6994
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: