Provider Demographics
NPI:1992258099
Name:URUCHIMA, LISA
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:URUCHIMA
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 1:11701 PARK LN S
Mailing Address - Street 2:APT D4E
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-1014
Mailing Address - Country:US
Mailing Address - Phone:917-679-0880
Mailing Address - Fax:
Practice Address - Street 1:11701 PARK LN S
Practice Address - Street 2:APT D4E
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-1014
Practice Address - Country:US
Practice Address - Phone:917-679-0880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist