Individual provider Active NPI

Maria Jannet Roman Urquiza

  • Mental Health Counselor
  • Moreno Valley, CA
National Provider Identifier
1760936520
Registry record updated Jun 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
77944 Issued in CA
Practice address
13800 Heacock St Ste D111
Moreno Valley, CA 92553-3340
Phone
(951) 653-1800
NPI assigned
Aug 10, 2016
Last updated
Jun 7, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 77944 CA Primary
Student in an Organized Health Care Education/Training Program 390200000X NU

Addresses

Primary practice location

13800 Heacock St Ste D111
Moreno Valley, CA 92553-3340

Mailing address

13800 Heacock St Ste C220
Moreno Valley, CA 92553-3363
Phone (951) 653-1800

Other practice location 1

855 N Euclid Ave
Ontario, CA 91762
Phone (909) 983-2020

Other practice location 2

1200 N Main St Ste 100B
Santa Ana, CA 92701-3630
Phone (714) 480-6661

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
77944CAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Special Service for Groups, Inc. CurrentSince May 1, 2021 Accepting new patients

Locations

13800 Heacock St
Ste C220
Moreno Valley, CA 92553
Phone (951) 243-4192

13800 Heacock St
Ste D111
Moreno Valley, CA 92553
Phone (951) 243-4192

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1470787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654560000000",
    "number": "1760936520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13800 HEACOCK ST STE C220",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925533363",
            "telephone_number": "951-653-1800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13800 HEACOCK ST STE D111",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925533340",
            "telephone_number": "951-653-1800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "855 N Euclid Ave",
            "address_purpose": "LOCATION",
            "city": "Ontario",
            "state": "CA",
            "postal_code": "91762",
            "country_code": "US",
            "telephone_number": "909-983-2020",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1200 N Main St Ste 100B",
            "address_purpose": "LOCATION",
            "city": "Santa Ana",
            "state": "CA",
            "postal_code": "927013630",
            "country_code": "US",
            "telephone_number": "714-480-6661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROMAN URQUIZA",
        "first_name": "MARIA",
        "middle_name": "JANNET",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-10",
        "last_updated": "2022-06-07",
        "certification_date": "2022-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "77944",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moreno Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.