Provider Demographics
NPI:1699360891
Name:URQUIA MORA, YOAND
Entity Type:Individual
Prefix:
First Name:YOAND
Middle Name:
Last Name:URQUIA MORA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 W EASTWOOD AVE APT 605
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-6603
Mailing Address - Country:US
Mailing Address - Phone:312-678-5193
Mailing Address - Fax:
Practice Address - Street 1:917 W EASTWOOD AVE APT 605
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-6603
Practice Address - Country:US
Practice Address - Phone:312-678-5193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.022950363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology