Healthcare Provider Details

I. General information

NPI: 1427607738
Provider Name (Legal Business Name): BRIDGET M. URENA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14600 SHERMAN WAY STE 100D
VAN NUYS CA
91405-5869
US

IV. Provider business mailing address

14600 SHERMAN WAY STE 100D
VAN NUYS CA
91405-5869
US

V. Phone/Fax

Practice location:
  • Phone: 818-374-6901
  • Fax:
Mailing address:
  • Phone: 818-374-6901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberACSW95466
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: