Healthcare Provider Details

I. General information

NPI: 1154992022
Provider Name (Legal Business Name): DEHUSSA URBIETA DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2021
Last Update Date: 07/23/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HEALTH CLINIC HAWAII 480 CENTRAL AVENUE
PEARL HARBOR HI
99686
US

IV. Provider business mailing address

NAVAL HEALTH CLINIC HAWAII 480 CENTRAL AVENUE
PEARL HARBOR HI
99686
US

V. Phone/Fax

Practice location:
  • Phone: 808-474-4242
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95017750
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95017750
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: