Provider Demographics
NPI:1649987439
Name:URBANO, NELLINA
Entity type:Individual
Prefix:
First Name:NELLINA
Middle Name:
Last Name:URBANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17901 NW 68TH AVE APT R105
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3918
Mailing Address - Country:US
Mailing Address - Phone:786-458-1603
Mailing Address - Fax:
Practice Address - Street 1:17901 NW 68TH AVE APT R105
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-3918
Practice Address - Country:US
Practice Address - Phone:786-458-1603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCM-0105386-P171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty