# LAKE HAVASU OB/GYN, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1598944811
- **Authorized official:** DR. MARY JO VITA URSO D.O. (OWNER)
- **Authorized official phone:** (928) 680-2846

## Contact information

- **Practice address:** 99 RIVIERA DR, LAKE HAVASU CITY, AZ 86403-5713
- **Practice address phone:** (928) 680-2846
- **Practice address fax:** (928) 680-2845
- **Mailing address:** 99 RIVIERA DR, LAKE HAVASU CITY, AZ 86403-5713
- **Mailing address phone:** (928) 680-2846
- **Mailing address fax:** (928) 680-2845

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 20A8265 | CA | — |
| 261QM2500X | Medical Specialty Clinic/Center | 3696 | AZ | Yes |

## Other

- **Enumeration date:** 11/02/2007
- **Last updated:** 02/29/2012