Healthcare Provider Details

I. General information

NPI: 1558803718
Provider Name (Legal Business Name): PENNY E URBINA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2016
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 RIO RANCHO BLVD NE STE 203
RIO RANCHO NM
87124-1456
US

IV. Provider business mailing address

333 RIO RANCHO BLVD NE STE 203
RIO RANCHO NM
87124-1456
US

V. Phone/Fax

Practice location:
  • Phone: 505-659-5939
  • Fax:
Mailing address:
  • Phone: 505-659-5939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-10405
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM-08904
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: