Healthcare Provider Details

I. General information

NPI: 1962064048
Provider Name (Legal Business Name): AMANDA HURTADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2019
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 STINE RD
BAKERSFIELD CA
93309-4176
US

IV. Provider business mailing address

4909 MORRO DR
BAKERSFIELD CA
93307-3044
US

V. Phone/Fax

Practice location:
  • Phone: 661-396-2301
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: