Healthcare Provider Details

I. General information

NPI: 1427525922
Provider Name (Legal Business Name): SHELLEY HURGUY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2018
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 ROLLING OAKS DR STE 110
THOUSAND OAKS CA
91361-1299
US

IV. Provider business mailing address

PO BOX 7032
VENTURA CA
93006-7032
US

V. Phone/Fax

Practice location:
  • Phone: 909-946-5752
  • Fax:
Mailing address:
  • Phone: 323-376-6121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: SHELLEY HURGUY
Title or Position: OWNER
Credential: CRNA
Phone: 323-376-6121