Healthcare Provider Details

I. General information

NPI: 1821337668
Provider Name (Legal Business Name): JOSEPH ROBERT UMBRINO NURSE PRACTITIONER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2013
Last Update Date: 02/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 WILSHIRE BLVD
LOS ANGELES CA
90057-3602
US

IV. Provider business mailing address

1044 1/2 N CRESCENT HEIGHTS BLVD
LOS ANGELES CA
90046-6008
US

V. Phone/Fax

Practice location:
  • Phone: 213-484-9934
  • Fax: 213-484-9939
Mailing address:
  • Phone: 323-243-8602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22669
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: