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General NPI Number Information
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NPI Number | 1043265903
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Entity Type | Organization
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Legal Business Name | URGIKIDS
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Dates
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Enumeration Date | 05/22/2006
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Last Update Date | 02/10/2010
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Provider Practice Location Address
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Address Line | 1190 BAKER ST 100
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City | COSTA MESA
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State | CA
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Zip | 92626-4108
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Country | US
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Telephone | 714-668-2540
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Fax | 714-668-2510
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Provider Business Mailing Address
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Address Line | PO BOX 15277
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City | NEWPORT BEACH
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State | CA
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Zip | 92659-5277
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Country | US
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Telephone | 714-668-2540
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Fax | 714-668-2510
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANDREW BLUMBERG
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Credential | M.D
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Telephone | 714-668-2510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A29438
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License Number State | CA
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