Healthcare Provider Details

I. General information

NPI: 1487225579
Provider Name (Legal Business Name): VICTOR URBINA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 04/04/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7610 40TH ST W STE 200
UNIVERSITY PLACE WA
98466-3838
US

IV. Provider business mailing address

7610 40TH ST W STE 200
UNIVERSITY PLACE WA
98466-3838
US

V. Phone/Fax

Practice location:
  • Phone: 253-830-6242
  • Fax:
Mailing address:
  • Phone: 253-830-6242
  • 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: