Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) |
NPI | 1003294141 |
---|---|
Provider Name | Jaime Urbina |
First Address | Los Angeles, CA 90032-2554 |
Second Address | Los Angeles, CA 90032-2554 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2015 |
Last Update Date | 08/05/2015 |