Healthcare Provider Details

I. General information

NPI: 1235916529
Provider Name (Legal Business Name): KENNETH URBANSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 TAYLOR ST
MONTEREY CA
93940-2039
US

IV. Provider business mailing address

3356 MICHAEL DR
MARINA CA
93933-2314
US

V. Phone/Fax

Practice location:
  • Phone: 831-521-6078
  • Fax:
Mailing address:
  • Phone: 408-706-0644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: