Healthcare Provider Details

I. General information

NPI: 1265693451
Provider Name (Legal Business Name): MRS. MAGDALENA NORA URRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7312 SW 139TH CT
MIAMI FL
33183-3148
US

IV. Provider business mailing address

7312 SW 139TH CT
MIAMI FL
33183-3148
US

V. Phone/Fax

Practice location:
  • Phone: 305-776-7296
  • Fax: 305-408-3941
Mailing address:
  • Phone: 305-776-7296
  • Fax: 305-408-3941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number122383
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: