Healthcare Provider Details

I. General information

NPI: 1356674113
Provider Name (Legal Business Name): CYNTHIA JEAN HURN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2009
Last Update Date: 09/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 GLENDALE LN STE 100
SACRAMENTO CA
95825-2455
US

IV. Provider business mailing address

3 COLBY CT
SACRAMENTO CA
95825-7005
US

V. Phone/Fax

Practice location:
  • Phone: 916-531-2806
  • Fax:
Mailing address:
  • Phone: 916-921-9934
  • Fax:

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: