Healthcare Provider Details

I. General information

NPI: 1538690607
Provider Name (Legal Business Name): MYLA URBANO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 FLOYD AVE APT 27
MODESTO CA
95355-9464
US

IV. Provider business mailing address

2800 FLOYD AVE APT 27
MODESTO CA
95355-9464
US

V. Phone/Fax

Practice location:
  • Phone: 209-606-6081
  • Fax:
Mailing address:
  • Phone: 209-606-6081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95005591
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: