Provider Demographics
NPI:1578584744
Name:URBACH, KATRINA RENATA (MD)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:RENATA
Last Name:URBACH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1000 S ELISEO DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2133
Mailing Address - Country:US
Mailing Address - Phone:415-461-5436
Mailing Address - Fax:415-461-1006
Practice Address - Street 1:1000 S ELISEO DR
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2133
Practice Address - Country:US
Practice Address - Phone:415-461-5436
Practice Address - Fax:415-461-1006
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG51250208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAUA51947Medicare UPIN