Healthcare Provider Details

I. General information

NPI: 1952737058
Provider Name (Legal Business Name): MR. ISAIAH HURTADO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2013
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 GROVE ST
SAN FRANCISCO CA
94102-4505
US

IV. Provider business mailing address

101 GROVE ST
SAN FRANCISCO CA
94102-4505
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-5655
  • Fax: 415-353-5653
Mailing address:
  • Phone: 415-401-2611
  • Fax: 415-401-2741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: