Healthcare Provider Details

I. General information

NPI: 1336875046
Provider Name (Legal Business Name): CHRISTINA MARIE URATA PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 E DYER RD
SANTA ANA CA
92705-5639
US

IV. Provider business mailing address

2021 S WAVERLY DR
ANAHEIM CA
92802-3928
US

V. Phone/Fax

Practice location:
  • Phone: 949-333-6400
  • Fax:
Mailing address:
  • Phone: 714-782-4603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number51141
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: