Healthcare Provider Details

I. General information

NPI: 1184020265
Provider Name (Legal Business Name): MR. THERON HURLBERT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2014
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2608 VICTOR AVE STE A
REDDING CA
96002-1447
US

IV. Provider business mailing address

PO BOX 950
RED BLUFF CA
96080-0950
US

V. Phone/Fax

Practice location:
  • Phone: 530-722-1022
  • Fax: 530-722-1058
Mailing address:
  • Phone: 530-528-2938
  • Fax: 530-528-8024

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: