Provider Demographics
NPI:1194023093
Name:URBINA, ANGELICA RUBY (PA- C)
Entity Type:Individual
Prefix:MS
First Name:ANGELICA
Middle Name:RUBY
Last Name:URBINA
Suffix:
Gender:F
Credentials:PA- C
Other - Prefix:
Other - First Name:ANGELICA
Other - Middle Name:RUBY
Other - Last Name:CANTU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:801 S MAIN ST
Mailing Address - Street 2:STE C
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-5055
Mailing Address - Country:US
Mailing Address - Phone:956-686-0574
Mailing Address - Fax:956-686-3301
Practice Address - Street 1:801 S MAIN ST
Practice Address - Street 2:STE C
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-5055
Practice Address - Country:US
Practice Address - Phone:956-686-0574
Practice Address - Fax:956-686-3301
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07109363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX407720YLPSOtherWELLMED PTAN
TX302009102Medicaid
TXTXB142056Medicare PIN