Healthcare Provider Details

I. General information

NPI: 1134536964
Provider Name (Legal Business Name): JOHN HURLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2014
Last Update Date: 09/29/2023
Certification Date: 09/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5184 CUNNINGHAM CT
CASTRO VALLEY CA
94546-2538
US

IV. Provider business mailing address

20885 REDWOOD RD # 420
CASTRO VALLEY CA
94546-5915
US

V. Phone/Fax

Practice location:
  • Phone: 707-363-6293
  • Fax:
Mailing address:
  • Phone: 510-516-0435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number99315
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: