Healthcare Provider Details

I. General information

NPI: 1669676847
Provider Name (Legal Business Name): NORELIA URENA MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 03/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3322 CHANATE RD
SANTA ROSA CA
95404-1708
US

IV. Provider business mailing address

3322 CHANATE RD
SANTA ROSA CA
95404-1708
US

V. Phone/Fax

Practice location:
  • Phone: 707-576-8181
  • Fax: 707-565-5183
Mailing address:
  • Phone: 707-576-8181
  • Fax: 707-565-5183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number52627
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: