Healthcare Provider Details

I. General information

NPI: 1679581565
Provider Name (Legal Business Name): IRINA A URUSOVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6221 WILSHIRE BLVD STE 220
LOS ANGELES CA
90048-5226
US

IV. Provider business mailing address

6221 WILSHIRE BLVD STE 220
LOS ANGELES CA
90048-5226
US

V. Phone/Fax

Practice location:
  • Phone: 323-954-9369
  • Fax: 323-954-1160
Mailing address:
  • Phone: 323-823-3924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberA67479
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: