Basic Information
| Provider Information | |||||||||
| NPI: | 1851597207 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | URBAN | ||||||||
| FirstName: | DOREEN | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | N.P. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SHEA | ||||||||
| OtherFirstName: | DOREEN | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | N.P. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 10148 STRATTON CT | ||||||||
| Address2: | |||||||||
| City: | ALTA LOMA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099895122 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 26800 CROWN VALLEY PKWY. | ||||||||
| Address2: | SUITE 330 | ||||||||
| City: | MISSION VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92691 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9493647246 | ||||||||
| FaxNumber: | 9493641647 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2007 | ||||||||
| LastUpdateDate: | 05/18/2010 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 3874554 | CA | N | Nursing Service Providers | Registered Nurse | 363L00000X | 6440 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | MEDICAL | 01 | CA | FHC70324F | OTHER | EAP703234F | 01 | CA | EAPC | OTHER | HAP70324F | 01 | CA | PACT | OTHER |