Healthcare Provider Details

I. General information

NPI: 1578317996
Provider Name (Legal Business Name): ANNJENETTE HURTADO MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2024
Last Update Date: 04/12/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9717 ELK GROVE FLORIN RD STE A
ELK GROVE CA
95624-2262
US

IV. Provider business mailing address

2141 FREEMAN CT
ANTIOCH CA
94509-5730
US

V. Phone/Fax

Practice location:
  • Phone: 916-585-3034
  • Fax:
Mailing address:
  • Phone: 925-325-1919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: