1366538340 NPI number — GONZALO URBANO M.D.

Table of content: GONZALO URBANO M.D. (NPI 1366538340)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366538340 NPI number — GONZALO URBANO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
URBANO
Provider First Name:
GONZALO
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366538340
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5715 N WEST AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93711-2376
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-438-0800
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5715 N WEST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93711-2376
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-438-0800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  180174 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000330940101 . This is a "HEALTH PLUS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 040426028328 . This is a "FIDELIS CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 149379 . This is a "WELLCARE HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 180174P . This is a "HEALTHCARE PARTNERS, INC. MEDICARE AND MEDICAID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01237998 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100087520001 . This is a "UHC MEDICAID FHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 180174-AIF . This is a "HEALTHFIRST" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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