Healthcare Provider Details

I. General information

NPI: 1467009639
Provider Name (Legal Business Name): ADRIAN HURTADO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2019
Last Update Date: 08/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 S 11TH ST
LOS BANOS CA
93635-4800
US

IV. Provider business mailing address

940 OAK GROVE RD
MODESTO CA
95351-7811
US

V. Phone/Fax

Practice location:
  • Phone: 209-827-0120
  • Fax:
Mailing address:
  • Phone: 209-581-8814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95051356
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: