Healthcare Provider Details

I. General information

NPI: 1942321906
Provider Name (Legal Business Name): ANNA G. HURTADO L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4305 GESNER ST # 101
SAN DIEGO CA
92117-6639
US

IV. Provider business mailing address

1958 2ND AVE APT 106
SAN DIEGO CA
92101-8307
US

V. Phone/Fax

Practice location:
  • Phone: 619-701-5226
  • Fax:
Mailing address:
  • Phone: 619-701-5226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC9933
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: