Provider Demographics
NPI:1609215995
Name:URIBE, MARCOS ESTEVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCOS
Middle Name:ESTEVAN
Last Name:URIBE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FILE #54701
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-4701
Mailing Address - Country:US
Mailing Address - Phone:909-558-6600
Mailing Address - Fax:
Practice Address - Street 1:25455 BARTON RD STE 209A
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3177
Practice Address - Country:US
Practice Address - Phone:909-558-6600
Practice Address - Fax:909-558-6033
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA138721207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine