Healthcare Provider Details

I. General information

NPI: 1225879604
Provider Name (Legal Business Name): JESSICA MARIA HURTADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2024
Last Update Date: 06/01/2024
Certification Date: 06/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2570 48TH ST
SACRAMENTO CA
95817-1541
US

IV. Provider business mailing address

1188 SEA REEF DR
SAN DIEGO CA
92154-8429
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-2145
  • Fax:
Mailing address:
  • Phone: 619-718-2008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: