Healthcare Provider Details

I. General information

NPI: 1750503199
Provider Name (Legal Business Name): URIA JEFFREY PARKS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9990 COUNTY FARM RD STE 6
RIVERSIDE CA
92503-3542
US

IV. Provider business mailing address

6476 RIVERSIDE AVE APT 8
RIVERSIDE CA
92506-3104
US

V. Phone/Fax

Practice location:
  • Phone: 951-358-7380
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: