Healthcare Provider Details

I. General information

NPI: 1508199191
Provider Name (Legal Business Name): AUGUSTINA URUBUSI NURSE PRACTITIONER(M
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14408 DARTMOOR AVE
NORWALK CA
90650
US

IV. Provider business mailing address

14408 DARTMOOR AVE
NORWALK CA
90650
US

V. Phone/Fax

Practice location:
  • Phone: 323-599-9795
  • Fax:
Mailing address:
  • Phone: 323-599-9795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN222004
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number2023005277
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95027587
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: