Healthcare Provider Details

I. General information

NPI: 1013034057
Provider Name (Legal Business Name): VANESSA TORRES HURTADO MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 05/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 MYERS ST
RIVERSIDE CA
92503-5525
US

IV. Provider business mailing address

7444 WOODGLEN DR
CORONA CA
92880-0716
US

V. Phone/Fax

Practice location:
  • Phone: 951-358-6895
  • Fax:
Mailing address:
  • Phone: 951-545-5528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number24791
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: