Provider Demographics
NPI:1083371496
Name:URREA, EDWARD ANTHONY
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:ANTHONY
Last Name:URREA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 W KEARNEY BLVD
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706-2702
Mailing Address - Country:US
Mailing Address - Phone:559-485-0501
Mailing Address - Fax:559-485-1313
Practice Address - Street 1:1414 W KEARNEY BLVD
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-2702
Practice Address - Country:US
Practice Address - Phone:559-485-0501
Practice Address - Fax:559-485-1313
Is Sole Proprietor?:No
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14580-RAC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)