Healthcare Provider Details

I. General information

NPI: 1942866165
Provider Name (Legal Business Name): CHRISTINE ANN HURLEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2019
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 FREMONT AVE STE 110
LOS ALTOS CA
94024-5602
US

IV. Provider business mailing address

851 FREMONT AVE STE 110
LOS ALTOS CA
94024-5602
US

V. Phone/Fax

Practice location:
  • Phone: 650-941-1698
  • Fax: 650-434-3953
Mailing address:
  • Phone: 650-941-1698
  • Fax: 650-434-3953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number025787
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number56785
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: