Healthcare Provider Details

I. General information

NPI: 1760735245
Provider Name (Legal Business Name): RENE URBINA ANP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2012
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16111 PLUMMER ST BLDG 70
NORTH HILLS CA
91343-2036
US

IV. Provider business mailing address

16111 PLUMMER ST BLDG 70
NORTH HILLS CA
91343-2036
US

V. Phone/Fax

Practice location:
  • Phone: 818-891-7711
  • Fax: 818-895-5808
Mailing address:
  • Phone: 818-891-7711
  • Fax: 818-895-5808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNPF21282
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: