Provider Demographics
NPI:1790971893
Name:URBINA, JORGE ALBERTO
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:ALBERTO
Last Name:URBINA
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 1:5300 TERNER WAY APT 7108
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95136-4141
Mailing Address - Country:US
Mailing Address - Phone:408-460-0968
Mailing Address - Fax:
Practice Address - Street 1:5300 TERNER WAY APT 7108
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95136-4141
Practice Address - Country:US
Practice Address - Phone:408-460-0968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health