Healthcare Provider Details

I. General information

NPI: 1235015967
Provider Name (Legal Business Name): DANIEL HURTADO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4485 GLINES AVE
SANTA MARIA CA
93455-6668
US

IV. Provider business mailing address

4485 GLINES AVE
SANTA MARIA CA
93455-6668
US

V. Phone/Fax

Practice location:
  • Phone: 805-956-2888
  • Fax:
Mailing address:
  • Phone: 805-956-2888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number231474C320
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: