Healthcare Provider Details

I. General information

NPI: 1710788237
Provider Name (Legal Business Name): ANGELICA HURTADO MS, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2025
Last Update Date: 03/21/2025
Certification Date: 03/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 SANTA ALICIA AVE APT 3102
CHULA VISTA CA
91913-1853
US

IV. Provider business mailing address

1390 SANTA ALICIA AVE APT 3102
CHULA VISTA CA
91913-1853
US

V. Phone/Fax

Practice location:
  • Phone: 760-642-9860
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: