Healthcare Provider Details

I. General information

NPI: 1063068443
Provider Name (Legal Business Name): ALYSSA KATE HURTADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2019
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 FORD ST
OAKLAND CA
94601-2114
US

IV. Provider business mailing address

35364 RAMSGATE DR
NEWARK CA
94560-1445
US

V. Phone/Fax

Practice location:
  • Phone: 510-926-0060
  • Fax:
Mailing address:
  • Phone: 518-312-3555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number88768
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number115546
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number088559-01
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW88768
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: