Healthcare Provider Details

I. General information

NPI: 1215086376
Provider Name (Legal Business Name): JOHN HURD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 05/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 MIDDLEFIELD RD
PALO ALTO CA
94301-3339
US

IV. Provider business mailing address

935 MIDDLEFIELD RD
PALO ALTO CA
94301-3339
US

V. Phone/Fax

Practice location:
  • Phone: 650-248-3499
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number33865
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: