Provider Demographics
NPI:1720375181
Name:URSALES, MAYBELLE LEIGH ORNOPIA (MD)
Entity Type:Individual
Prefix:DR
First Name:MAYBELLE LEIGH
Middle Name:ORNOPIA
Last Name:URSALES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4400 DUCKHORN DR STE 100
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-2680
Practice Address - Country:US
Practice Address - Phone:916-575-8000
Practice Address - Fax:916-575-8099
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA123021207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine