Healthcare Provider Details

I. General information

NPI: 1427372101
Provider Name (Legal Business Name): MANTON SCOTT HURD N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2010
Last Update Date: 09/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3626 BALBOA ST
SAN FRANCISCO CA
94121-2604
US

IV. Provider business mailing address

3626 BALBOA ST
SAN FRANCISCO CA
94121-2604
US

V. Phone/Fax

Practice location:
  • Phone: 415-668-5955
  • Fax: 415-668-0246
Mailing address:
  • Phone: 415-668-5955
  • Fax: 415-668-0246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number836388
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95004842
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: