Healthcare Provider Details

I. General information

NPI: 1871102590
Provider Name (Legal Business Name): SARAH HO HURD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71777 SAN JACINTO DR STE 202
RANCHO MIRAGE CA
92270-4457
US

IV. Provider business mailing address

71777 SAN JACINTO DR STE 202
RANCHO MIRAGE CA
92270-4457
US

V. Phone/Fax

Practice location:
  • Phone: 888-743-7526
  • Fax:
Mailing address:
  • Phone: 888-743-7526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95015063
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: