Healthcare Provider Details

I. General information

NPI: 1689834434
Provider Name (Legal Business Name): CIRILO HURTADO JR. PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 W WARNER AVE
SANTA ANA CA
92707-3147
US

IV. Provider business mailing address

1030 W WARNER AVE
SANTA ANA CA
92707-3147
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-6900
  • Fax:
Mailing address:
  • Phone: 714-834-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License NumberPT29011
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number29011
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: