Healthcare Provider Details

I. General information

NPI: 1306482682
Provider Name (Legal Business Name): MARIBEL HURTADO DACM, L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2019
Last Update Date: 11/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 LAS FLORES DR
CHULA VISTA CA
91910-1966
US

IV. Provider business mailing address

66 LAS FLORES DR
CHULA VISTA CA
91910-1966
US

V. Phone/Fax

Practice location:
  • Phone: 619-882-4260
  • Fax:
Mailing address:
  • Phone: 619-882-4260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number18420
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: