Healthcare Provider Details

I. General information

NPI: 1972304145
Provider Name (Legal Business Name): ANNE HURLEY PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2025
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 S MAIN ST STE 100
ORANGE CA
92868-4568
US

IV. Provider business mailing address

2069 MONROVIA AVE
COSTA MESA CA
92627-4138
US

V. Phone/Fax

Practice location:
  • Phone: 714-509-3919
  • Fax:
Mailing address:
  • Phone: 562-708-4379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA66126
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: