Healthcare Provider Details

I. General information

NPI: 1912278722
Provider Name (Legal Business Name): ARACELI BAUTISTA HURST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2012
Last Update Date: 11/30/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 W HOSPITALITY LN STE 110
SAN BERNARDINO CA
92408-3210
US

IV. Provider business mailing address

18313 RED BAY CT
SAN BERNARDINO CA
92407-9062
US

V. Phone/Fax

Practice location:
  • Phone: 909-332-7707
  • Fax: 909-823-5507
Mailing address:
  • Phone: 909-743-3131
  • 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 NumberLCSW82986
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: