Provider Demographics
NPI:1427747781
Name:URBINA VALENCIA, IDALIA
Entity type:Individual
Prefix:
First Name:IDALIA
Middle Name:
Last Name:URBINA VALENCIA
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 1:317 W LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-5645
Mailing Address - Country:US
Mailing Address - Phone:509-731-1711
Mailing Address - Fax:
Practice Address - Street 1:317 W LEWIS ST
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-5645
Practice Address - Country:US
Practice Address - Phone:509-731-1711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA21961041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool