Healthcare Provider Details

I. General information

NPI: 1619280351
Provider Name (Legal Business Name): ROBERT PERRY HURST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2010
Last Update Date: 07/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 GRANT ST
CONCORD CA
94520-2251
US

IV. Provider business mailing address

PO BOX 16142
OAKLAND CA
94610-6142
US

V. Phone/Fax

Practice location:
  • Phone: 510-773-6848
  • Fax:
Mailing address:
  • Phone: 415-308-4052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF69036
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT86906
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: