Healthcare Provider Details

I. General information

NPI: 1821498254
Provider Name (Legal Business Name): FERNANDO A URAGA JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2014
Last Update Date: 09/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1731 GROVE ST
RIDGEWOOD NY
11385-2155
US

IV. Provider business mailing address

1731 GROVE STREET
RIDGEWOOD NY
11385
US

V. Phone/Fax

Practice location:
  • Phone: 347-262-1638
  • Fax:
Mailing address:
  • Phone: 347-262-1638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: