Provider Demographics
NPI:1942080304
Name:URIZAR, ANGEL RODERICO JR
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:RODERICO
Last Name:URIZAR
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13929 E 14TH STREET
Mailing Address - Street 2:SUITE 190
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578
Mailing Address - Country:US
Mailing Address - Phone:510-714-0996
Mailing Address - Fax:
Practice Address - Street 1:13929 E 14TH STREET
Practice Address - Street 2:SUITE 190
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578
Practice Address - Country:US
Practice Address - Phone:510-714-0996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist