Provider Demographics
NPI:1811184526
Name:CARRILLO, URBINA & CASTUERA, MDS INC
Entity type:Organization
Organization Name:CARRILLO, URBINA & CASTUERA, MDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:URBINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-624-3033
Mailing Address - Street 1:4451 HOLT BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-4116
Mailing Address - Country:US
Mailing Address - Phone:909-624-3033
Mailing Address - Fax:909-624-8440
Practice Address - Street 1:4451 HOLT BLVD
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-4116
Practice Address - Country:US
Practice Address - Phone:909-624-3033
Practice Address - Fax:909-624-8440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71133208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH47353Medicare UPIN