Healthcare Provider Details

I. General information

NPI: 1356930218
Provider Name (Legal Business Name): MISS EVELYN M HURTADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2021
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13135 BARTON RD STE 100
WHITTIER CA
90605-2757
US

IV. Provider business mailing address

13135 BARTON RD
WHITTIER CA
90605-2757
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-9222
  • Fax:
Mailing address:
  • Phone: 714-215-9222
  • 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: