Healthcare Provider Details

I. General information

NPI: 1689371577
Provider Name (Legal Business Name): MARIA HURTADO LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2023
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 MOORPARK AVE STE 300
SAN JOSE CA
95128-2680
US

IV. Provider business mailing address

2245 LANAI AVE APT 87
SAN JOSE CA
95122-2437
US

V. Phone/Fax

Practice location:
  • Phone: 408-975-2730
  • Fax: 408-975-2745
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number699169
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: