Healthcare Provider Details

I. General information

NPI: 1730333105
Provider Name (Legal Business Name): ADRIANA HURTADO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 11/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27155 CHERRY LAUREL PL
CANYON COUNTRY CA
91387-3819
US

IV. Provider business mailing address

27155 CHERRY LAUREL PL
CANYON COUNTRY CA
91387-3819
US

V. Phone/Fax

Practice location:
  • Phone: 661-857-2315
  • Fax: 818-920-0180
Mailing address:
  • Phone: 661-857-2315
  • Fax: 818-920-0180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number57445
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: