Provider Demographics
NPI:1649274663
Name:URBANO, WIVINA TALABIS (MD)
Entity type:Individual
Prefix:DR
First Name:WIVINA
Middle Name:TALABIS
Last Name:URBANO
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Gender:F
Credentials:MD
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Mailing Address - Street 1:4600 SOUTH TRACY BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377
Mailing Address - Country:US
Mailing Address - Phone:209-833-1628
Mailing Address - Fax:209-833-9847
Practice Address - Street 1:4600 SOUTH TRACY BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95377
Practice Address - Country:US
Practice Address - Phone:209-833-1628
Practice Address - Fax:209-833-9847
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2012-01-31
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Provider Licenses
StateLicense IDTaxonomies
CAA068692208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H04217Medicare UPIN