Healthcare Provider Details

I. General information

NPI: 1962270223
Provider Name (Legal Business Name): RICARDO JOSE HURTADO MT-BC; NMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 12/18/2023
Certification Date: 12/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3131 FOOTHILL BLVD STE I
LA CRESCENTA CA
91214-4231
US

IV. Provider business mailing address

2313 ROSECREST DR APT 11
GLENDALE CA
91208-1352
US

V. Phone/Fax

Practice location:
  • Phone: 818-605-8441
  • Fax:
Mailing address:
  • Phone: 818-605-8441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number14584
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: