Healthcare Provider Details

I. General information

NPI: 1942950696
Provider Name (Legal Business Name): CANDY MARIE HURTADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 03/25/2022
Certification Date: 03/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39201 STATE ST
FREMONT CA
94538-1437
US

IV. Provider business mailing address

2922 FLORIDA AVE
STOCKTON CA
95205-2815
US

V. Phone/Fax

Practice location:
  • Phone: 866-206-2008
  • Fax:
Mailing address:
  • Phone:
  • 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: