Healthcare Provider Details

I. General information

NPI: 1487957700
Provider Name (Legal Business Name): YUDELKA URENA MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2010
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 W 239TH ST
BRONX NY
10463-1205
US

IV. Provider business mailing address

4967 NEWPORT AVE STE 12 BOX 485
SAN DIEGO CA
92107
US

V. Phone/Fax

Practice location:
  • Phone: 718-601-2280
  • Fax:
Mailing address:
  • Phone: 619-218-0250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number082507
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: