Healthcare Provider Details

I. General information

NPI: 1841785995
Provider Name (Legal Business Name): BIANCA HUR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 05/19/2024
Certification Date: 05/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 E 4TH ST
SANTA ANA CA
92701-5163
US

IV. Provider business mailing address

147 PORT
IRVINE CA
92618-1163
US

V. Phone/Fax

Practice location:
  • Phone: 949-232-0105
  • Fax:
Mailing address:
  • Phone: 929-244-5556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number34803
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: