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: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3947 LENNANE DR STE 110
SACRAMENTO CA
95834-1971
US

IV. Provider business mailing address

590 VALLOMBROSA AVE
CHICO CA
95926-4038
US

V. Phone/Fax

Practice location:
  • Phone: 916-283-8280
  • Fax: 916-283-8259
Mailing address:
  • Phone: 916-330-8017
  • Fax: 530-330-8018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: