Provider Demographics
NPI:1568746774
Name:URBINA, JESSICA YVETTE (MS)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:YVETTE
Last Name:URBINA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8142 GARDEN PARK ST
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91708-9347
Mailing Address - Country:US
Mailing Address - Phone:714-331-1616
Mailing Address - Fax:
Practice Address - Street 1:8142 GARDEN PARK ST
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91708-9347
Practice Address - Country:US
Practice Address - Phone:714-331-1616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62725106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist