Provider Demographics
NPI:1386642783
Name:URSO, MARY JO VITA (DO)
Entity Type:Individual
Prefix:DR
First Name:MARY JO
Middle Name:VITA
Last Name:URSO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1515 W FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-3817
Mailing Address - Country:US
Mailing Address - Phone:951-929-8400
Mailing Address - Fax:951-929-8411
Practice Address - Street 1:1515 W FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543
Practice Address - Country:US
Practice Address - Phone:951-929-8400
Practice Address - Fax:951-929-8411
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3696207V00000X
CA20A8265207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ635526Medicaid
AZZ77614Medicare PIN