Healthcare Provider Details

I. General information

NPI: 1700715943
Provider Name (Legal Business Name): JANE HURST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15339 SATICOY ST
VAN NUYS CA
91406-3345
US

IV. Provider business mailing address

13142 WOODCOCK AVE
SYLMAR CA
91342-3825
US

V. Phone/Fax

Practice location:
  • Phone: 818-267-2681
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberAMFT160752
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: