Healthcare Provider Details

I. General information

NPI: 1528240868
Provider Name (Legal Business Name): JOSE GUADAUPE HURTADO LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10901 MACARTHUR BLVD STE 201
OAKLAND CA
94605
US

IV. Provider business mailing address

2600 SAN LEANDRO BLVD APT 1319
SAN LEANDRO CA
94578-5048
US

V. Phone/Fax

Practice location:
  • Phone: 510-502-3280
  • Fax: 510-868-1940
Mailing address:
  • Phone: 831-600-5175
  • Fax: 510-868-1940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW76919
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: