Healthcare Provider Details

I. General information

NPI: 1821762659
Provider Name (Legal Business Name): MARIA GUADALUPE HURTADO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2021
Last Update Date: 08/05/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 3RD ST
NAPA CA
94559-3015
US

IV. Provider business mailing address

4016 BROWNS VALLEY RD
NAPA CA
94558-4105
US

V. Phone/Fax

Practice location:
  • Phone: 707-253-4384
  • Fax:
Mailing address:
  • Phone: 707-227-4957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95017913
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: