Healthcare Provider Details

I. General information

NPI: 1235546995
Provider Name (Legal Business Name): HURTT FAMILY HEALTH CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 11/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOPE DR
TUSTIN CA
92782-0221
US

IV. Provider business mailing address

1 HOPE DR
TUSTIN CA
92782-0221
US

V. Phone/Fax

Practice location:
  • Phone: 714-247-4398
  • Fax: 714-566-6475
Mailing address:
  • Phone: 714-247-0300
  • Fax: 714-259-1598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number060000772
License Number StateCA

VIII. Authorized Official

Name: BECKY CARTER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 714-247-8044