Healthcare Provider Details

I. General information

NPI: 1790377653
Provider Name (Legal Business Name): ALLISON N URBANIAK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4081 E OLYMPIC BLVD
LOS ANGELES CA
90023-3330
US

IV. Provider business mailing address

8161 E KAISER BLVD UNIT 27601
ANAHEIM CA
92809-0427
US

V. Phone/Fax

Practice location:
  • Phone: 323-267-0477
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: