Provider Demographics
NPI:1871866897
Name:URBAN RETREAT INC
Entity Type:Organization
Organization Name:URBAN RETREAT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:
Authorized Official - Last Name:VELAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-249-9176
Mailing Address - Street 1:4450 NE 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33308-5112
Mailing Address - Country:US
Mailing Address - Phone:954-249-9176
Mailing Address - Fax:
Practice Address - Street 1:4450 NE 20TH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33308-5112
Practice Address - Country:US
Practice Address - Phone:954-249-9176
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA32984174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty