Healthcare Provider Details

I. General information

NPI: 1427213057
Provider Name (Legal Business Name): BERTHA MIRIAM HURTADO PHYSICAL THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BERTHA MIRIAM HERNANDEZ PHYSICAL THERAPIST

II. Dates (important events)

Enumeration Date: 07/23/2008
Last Update Date: 07/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 MIRANDA AVE
PALO ALTO CA
94304-1207
US

IV. Provider business mailing address

71 EMPIRE CT
MOUNTAIN VIEW CA
94040-1591
US

V. Phone/Fax

Practice location:
  • Phone: 650-493-5000
  • Fax:
Mailing address:
  • Phone: 650-691-0360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 22584
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: