Healthcare Provider Details

I. General information

NPI: 1205587052
Provider Name (Legal Business Name): MARIA URENA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2022
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23920 SUNNYMEAD BLVD
MORENO VALLEY CA
92553-3060
US

IV. Provider business mailing address

23922 SUNNYMEAD BLVD
MORENO VALLEY CA
92553-3060
US

V. Phone/Fax

Practice location:
  • Phone: 951-481-1710
  • Fax:
Mailing address:
  • Phone: 951-481-1710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21401
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: