Healthcare Provider Details

I. General information

NPI: 1730616525
Provider Name (Legal Business Name): CLAUDIA HURTADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425 POMONA BLVD
LOS ANGELES CA
90022-1716
US

IV. Provider business mailing address

5425 POMONA BLVD
LOS ANGELES CA
90022-1716
US

V. Phone/Fax

Practice location:
  • Phone: 323-832-7504
  • Fax:
Mailing address:
  • Phone: 323-832-7504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number499224
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: