Healthcare Provider Details

I. General information

NPI: 1689838054
Provider Name (Legal Business Name): MRS. MILUSKA IRELA UGARTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 10/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 STAR CT
VIRGINIA BEACH VA
23456-1311
US

IV. Provider business mailing address

1720 STAR CT
VIRGINIA BEACH VA
23456-1311
US

V. Phone/Fax

Practice location:
  • Phone: 757-471-6724
  • Fax: 757-471-6724
Mailing address:
  • Phone: 757-471-6724
  • Fax: 757-471-6724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: