Healthcare Provider Details

I. General information

NPI: 1659945863
Provider Name (Legal Business Name): HURTT FAMILY HEALTH CLINIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14642 NEWPORT AVE STE 200
TUSTIN CA
92780-6058
US

IV. Provider business mailing address

14642 NEWPORT AVE STE 300
TUSTIN CA
92780-6059
US

V. Phone/Fax

Practice location:
  • Phone: 714-247-0300
  • Fax:
Mailing address:
  • Phone: 714-247-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: BECKY CARTER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 714-247-4304