MEDICARE: MRS. MILUSKA IRELA UGARTE

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	246Z00000X	Other Specialist/Technologist

General Provider Information

NPI Number	:	1689838054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MILUSKA IRELA UGARTE

Provider Business Mailing Address
First Line	:	1720 STAR CT
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-1311
Country	:	US
Telephone Number	:	757-471-6724
Fax Number	:	757-471-6724

Provider Business Practice Location Address
First Line	:	1720 STAR CT
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-1311
Country	:	US
Telephone Number	:	757-471-6724
Fax Number	:	757-471-6724

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

Provider Enumeration Date	:	07/15/2008
Last Update Date	:	10/29/2008

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