Provider Demographics
NPI:1598409971
Name:URIAS GONZALES, IDALIA ITALI (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:IDALIA
Middle Name:ITALI
Last Name:URIAS GONZALES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MRS
Other - First Name:IDALIA
Other - Middle Name:ITALI
Other - Last Name:URIAS-GONZALES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:1130 E MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2718
Mailing Address - Country:US
Mailing Address - Phone:602-283-4711
Mailing Address - Fax:602-671-4260
Practice Address - Street 1:1130 E MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2718
Practice Address - Country:US
Practice Address - Phone:602-283-4711
Practice Address - Fax:602-671-4260
Is Sole Proprietor?:No
Enumeration Date:2022-04-22
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ274028363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ84-4869956OtherIRS