Healthcare Provider Details

I. General information

NPI: 1538032453
Provider Name (Legal Business Name): GERALDINE HURTADO PHI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2025
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 SAN LEANDRO BLVD
SAN LEANDRO CA
94577-1595
US

IV. Provider business mailing address

1100 SAN LEANDRO BLVD
SAN LEANDRO CA
94577-1595
US

V. Phone/Fax

Practice location:
  • Phone: 510-913-0166
  • Fax: 510-268-2036
Mailing address:
  • Phone: 510-913-0166
  • Fax: 510-268-2036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: