Healthcare Provider Details

I. General information

NPI: 1972156388
Provider Name (Legal Business Name): JESSICA DENISSE HURTADO TAPIA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BON AIR RD
GREENBRAE CA
94904-1702
US

IV. Provider business mailing address

500 ALLERTON ST FL 2
REDWOOD CITY CA
94063-1519
US

V. Phone/Fax

Practice location:
  • Phone: 415-473-6392
  • Fax:
Mailing address:
  • Phone: 650-599-9955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: