Healthcare Provider Details

I. General information

NPI: 1336499946
Provider Name (Legal Business Name): MARTIN URBINA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2012
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4149 HIGHLINE BLVD SUITE 390, 400
OKLAHOMA CITY OK
73108-2103
US

IV. Provider business mailing address

PO BOX 48
MEAD OK
73449-0048
US

V. Phone/Fax

Practice location:
  • Phone: 405-949-1000
  • Fax: 405-949-1063
Mailing address:
  • Phone: 580-745-9610
  • Fax: 580-745-9650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: