Healthcare Provider Details

I. General information

NPI: 1164361382
Provider Name (Legal Business Name): CASSANDRA HURLBUT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 N MARENGO AVE
PASADENA CA
91103-2217
US

IV. Provider business mailing address

10746 NEW HAVEN ST UNIT 6
SUN VALLEY CA
91352-5421
US

V. Phone/Fax

Practice location:
  • Phone: 808-497-2970
  • Fax:
Mailing address:
  • Phone: 808-497-2970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRT1437220326
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: