Healthcare Provider Details

I. General information

NPI: 1396811477
Provider Name (Legal Business Name): GENE HURWIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 10/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3624 WESLEY ST
CULVER CITY CA
90232-2435
US

IV. Provider business mailing address

3624 WESLEY ST
CULVER CITY CA
90232-2435
US

V. Phone/Fax

Practice location:
  • Phone: 310-837-7849
  • Fax: 310-496-0512
Mailing address:
  • Phone: 310-237-3972
  • Fax: 310-496-0512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number4463
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: