Provider Demographics
NPI:1508199191
Name:URUBUSI, AUGUSTINA (NURSE PRACTITIONER(M)
Entity Type:Individual
Prefix:MS
First Name:AUGUSTINA
Middle Name:
Last Name:URUBUSI
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER(M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14408 DARTMOOR AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650
Mailing Address - Country:US
Mailing Address - Phone:323-599-9795
Mailing Address - Fax:
Practice Address - Street 1:14408 DARTMOOR AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650
Practice Address - Country:US
Practice Address - Phone:323-599-9795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN222004164X00000X
CA2023005277164X00000X
CA95027587363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No164X00000XNursing Service ProvidersLicensed Vocational Nurse