Healthcare Provider Details

I. General information

NPI: 1609215995
Provider Name (Legal Business Name): MARCOS ESTEVAN URIBE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 09/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25455 BARTON RD STE 209A
LOMA LINDA CA
92354-3177
US

IV. Provider business mailing address

FILE #54701
LOS ANGELES CA
90074-4701
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-6600
  • Fax: 909-558-6033
Mailing address:
  • Phone: 909-558-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA138721
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: