Healthcare Provider Details

I. General information

NPI: 1003457565
Provider Name (Legal Business Name): TATIANA MONIQUE HURTADO PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2019
Last Update Date: 10/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 DEL PASO BLVD
SACRAMENTO CA
95815-3102
US

IV. Provider business mailing address

246 CADILLAC DRIVE #110
SACRAMENTO CA
95825
US

V. Phone/Fax

Practice location:
  • Phone: 916-924-7988
  • Fax:
Mailing address:
  • Phone: 559-801-7062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: