Provider Demographics
NPI:1821337668
Name:UMBRINO, JOSEPH ROBERT (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ROBERT
Last Name:UMBRINO
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 1/2 N CRESCENT HEIGHTS BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-6008
Mailing Address - Country:US
Mailing Address - Phone:323-243-8602
Mailing Address - Fax:
Practice Address - Street 1:1800 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-3602
Practice Address - Country:US
Practice Address - Phone:213-484-9934
Practice Address - Fax:213-484-9939
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-13
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22669363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily