Healthcare Provider Details

I. General information

NPI: 1235897810
Provider Name (Legal Business Name): TRINI MICHELLE-LAILIE HURTADO REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2021
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 E HILTON AVE
MESA AZ
85204-5938
US

IV. Provider business mailing address

1445 E HILTON AVE
MESA AZ
85204-5938
US

V. Phone/Fax

Practice location:
  • Phone: 480-472-6175
  • Fax: 480-472-6150
Mailing address:
  • Phone: 480-472-6175
  • Fax: 480-472-6150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number250153
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: