Healthcare Provider Details

I. General information

NPI: 1528613544
Provider Name (Legal Business Name): CESAR OCTAVIO HURTADO AMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2019
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8330 RESEDA BLVD
NORTHRIDGE CA
91324-4619
US

IV. Provider business mailing address

7121 PARK MANOR AVE
NORTH HOLLYWOOD CA
91605-4414
US

V. Phone/Fax

Practice location:
  • Phone: 818-996-1051
  • Fax: 818-975-5072
Mailing address:
  • Phone: 818-254-6727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT113092
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: