Healthcare Provider Details

I. General information

NPI: 1194430405
Provider Name (Legal Business Name): LILIANA HURTADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2023
Last Update Date: 01/20/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 N R ST STE 101
MADERA CA
93637-4465
US

IV. Provider business mailing address

36579 ORANGE GROVE AVE
MADERA CA
93636-8618
US

V. Phone/Fax

Practice location:
  • Phone: 559-662-0527
  • Fax:
Mailing address:
  • Phone: 559-940-9631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: