Provider Demographics
NPI:1851597207
Name:URBAN, DOREEN ANN (NP)
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:ANN
Last Name:URBAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DOREEN
Other - Middle Name:
Other - Last Name:SHEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:10148 STRATTON CT
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91701
Mailing Address - Country:US
Mailing Address - Phone:909-989-5122
Mailing Address - Fax:
Practice Address - Street 1:26800 CROWN VALLEY PKWY.
Practice Address - Street 2:SUITE 330
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691
Practice Address - Country:US
Practice Address - Phone:949-364-7246
Practice Address - Fax:949-364-1647
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3874554163W00000X
CA6440363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMEDICALOtherFHC70324F
CAEAP703234FOtherEAPC
CAHAP70324FOtherPACT
CAEAP703234FOtherEAPC
CA051896Medicare ID - Type UnspecifiedMEDICARE