Healthcare Provider Details

I. General information

NPI: 1003187006
Provider Name (Legal Business Name): KATHLEEN HURWITZ M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2012
Last Update Date: 01/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25395 HANCOCK AVE SUITE 250
MURRIETA CA
92562-9054
US

IV. Provider business mailing address

25395 HANCOCK AVE SUITE 250
MURRIETA CA
92562-9054
US

V. Phone/Fax

Practice location:
  • Phone: 951-698-0300
  • Fax: 951-698-3719
Mailing address:
  • Phone: 951-698-0300
  • Fax: 951-698-3719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG61204
License Number StateCA

VIII. Authorized Official

Name: MS. SUSAN FORD
Title or Position: BILLER
Credential:
Phone: 951-694-6102