Healthcare Provider Details

I. General information

NPI: 1023848272
Provider Name (Legal Business Name): GISELLE M HURTADO MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2024
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7715 LEEDS ST
DOWNEY CA
90242-3489
US

IV. Provider business mailing address

9375 ARCHIBALD AVE STE 107
RANCHO CUCAMONGA CA
91730-5728
US

V. Phone/Fax

Practice location:
  • Phone: 562-719-2866
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW124685
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: