Healthcare Provider Details

I. General information

NPI: 1225825052
Provider Name (Legal Business Name): PAMELA HURTADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1899 W MALVERN AVE
FULLERTON CA
92833-2403
US

IV. Provider business mailing address

15533 BLUEFIELD AVE
LA MIRADA CA
90638-5332
US

V. Phone/Fax

Practice location:
  • Phone: 562-762-6576
  • Fax:
Mailing address:
  • Phone: 562-762-6576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: