Healthcare Provider Details

I. General information

NPI: 1275894644
Provider Name (Legal Business Name): KYJA HURST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2012
Last Update Date: 06/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3132 JEFFERSON ST
SAN DIEGO CA
92110-4421
US

IV. Provider business mailing address

7900 MICHELLE DR
LA MESA CA
91942-2532
US

V. Phone/Fax

Practice location:
  • Phone: 619-683-3100
  • Fax:
Mailing address:
  • Phone: 619-335-0301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN185360
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: