Provider Demographics
NPI:1437758893
Name:OLAZABAL, URSULA (PHD CSHC)
Entity type:Individual
Prefix:DR
First Name:URSULA
Middle Name:
Last Name:OLAZABAL
Suffix:
Gender:F
Credentials:PHD CSHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 WAVECREST AVE APT 302
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-3270
Mailing Address - Country:US
Mailing Address - Phone:321-749-0217
Mailing Address - Fax:
Practice Address - Street 1:402 N BABCOCK ST STE 101
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-7335
Practice Address - Country:US
Practice Address - Phone:321-259-0555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-18
Last Update Date:2020-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist