Provider Demographics
NPI:1164063038
Name:URBINA, STELLA
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:
Last Name:URBINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E TROPICANA AVE STE 158
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6516
Mailing Address - Country:US
Mailing Address - Phone:702-450-1704
Mailing Address - Fax:702-650-0201
Practice Address - Street 1:1500 E TROPICANA AVE STE 158
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6516
Practice Address - Country:US
Practice Address - Phone:702-450-1704
Practice Address - Fax:702-650-0201
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1603680444OtherDL