Healthcare Provider Details

I. General information

NPI: 1609498450
Provider Name (Legal Business Name): ARNEL URBIZTONDO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2020
Last Update Date: 05/15/2020
Certification Date: 05/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12902 USF MAGNOLIA DR
TAMPA FL
33612-9416
US

IV. Provider business mailing address

4915 8TH AVENUE
REGINA SK
S4T 0W2
CA

V. Phone/Fax

Practice location:
  • Phone: 813-745-6038
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number4301097784
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: