Healthcare Provider Details

I. General information

NPI: 1780952879
Provider Name (Legal Business Name): URDC HUMAN SERVICES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2011
Last Update Date: 12/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 E LIME AVE SUITE 101
MONROVIA CA
91016-2982
US

IV. Provider business mailing address

1460 N LAKE AVE SUITE 107
PASADENA CA
91104-2300
US

V. Phone/Fax

Practice location:
  • Phone: 626-249-0850
  • Fax: 626-249-0854
Mailing address:
  • Phone: 626-398-3796
  • Fax: 626-249-0854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number960000932
License Number StateCA

VIII. Authorized Official

Name: MS. SANDRA L ARRIVILLAGA
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 626-398-3796