Healthcare Provider Details

I. General information

NPI: 1740728831
Provider Name (Legal Business Name): GINGER HULST DNP, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2017
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 VIA EL PRADO STE 301
REDONDO BEACH CA
90277-5723
US

IV. Provider business mailing address

10650 REAGAN ST UNIT 824
LOS ALAMITOS CA
90720-8844
US

V. Phone/Fax

Practice location:
  • Phone: 310-698-5252
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95006140
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number95006140
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: