Healthcare Provider Details

I. General information

NPI: 1467198838
Provider Name (Legal Business Name): ANGELA MERCEDES HURTADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2022
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 LONGPORT CT STE 130
ELK GROVE CA
95758-7182
US

IV. Provider business mailing address

9656 WALNUT AVE
ELK GROVE CA
95624-2325
US

V. Phone/Fax

Practice location:
  • Phone: 916-224-1666
  • Fax:
Mailing address:
  • Phone: 916-212-8864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: