Basic Information
| Provider Information | |||||||||
| NPI: | 1821630070 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | URROZ | ||||||||
| FirstName: | MARVIN | ||||||||
| MiddleName: | DE JESUS | ||||||||
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| Credential: | ASW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 205 39TH ST | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 948052212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104125930 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2000 SIERRA RD. | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9253632000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2019 | ||||||||
| LastUpdateDate: | 09/10/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 88202 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.