Healthcare Provider Details

I. General information

NPI: 1053884908
Provider Name (Legal Business Name): CHARMAINE HURST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2019
Last Update Date: 01/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 S KINNELOA AVE
PASADENA CA
91107-3853
US

IV. Provider business mailing address

36 S KINNELOA AVE
PASADENA CA
91107-3853
US

V. Phone/Fax

Practice location:
  • Phone: 626-844-3033
  • Fax:
Mailing address:
  • Phone: 626-844-3033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: