Healthcare Provider Details

I. General information

NPI: 1932390374
Provider Name (Legal Business Name): REBECA MARCELA HURTADO MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 02/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 S GRAND AVE
GLENDORA CA
91740-4141
US

IV. Provider business mailing address

725 S GRAND AVE
GLENDORA CA
91740-4141
US

V. Phone/Fax

Practice location:
  • Phone: 626-691-1857
  • Fax: 626-691-1178
Mailing address:
  • Phone: 626-691-1857
  • Fax: 626-691-1178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: