Healthcare Provider Details

I. General information

NPI: 1912746538
Provider Name (Legal Business Name): DIANA HURTADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2024
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15490 CIVIC DR STE 103
VICTORVILLE CA
92392-2382
US

IV. Provider business mailing address

16269 SYCAMORE ST
HESPERIA CA
92345-2039
US

V. Phone/Fax

Practice location:
  • Phone: 442-327-9172
  • Fax:
Mailing address:
  • Phone: 951-903-8182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: