MEDICARE: VANESSA URBINA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	35120650	OH
2	208D00000X	General Practice Physician	ME122274	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396999447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA URBINA M.D.

Provider Business Mailing Address
First Line	:	6909 OLD HIGHWAY 441 S STE 104
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-7039
Country	:	US
Telephone Number	:	352-605-6958
Fax Number	:	352-729-4278

Provider Business Practice Location Address
First Line	:	6909 OLD HIGHWAY 441 S STE 104
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-7039
Country	:	US
Telephone Number	:	352-605-6958
Fax Number	:	352-309-7579

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2008
Last Update Date	:	06/13/2025

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