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General NPI Number Information
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NPI Number | 1528240868
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Entity Type | Individual
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Provider Name | JOSE GUADAUPE HURTADO LCSW
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Gender | Male
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Dates
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Enumeration Date | 11/28/2007
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Last Update Date | 06/18/2018
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Provider Practice Location Address
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Address Line | 10901 MACARTHUR BLVD STE 201
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City | OAKLAND
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State | CA
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Zip | 94605
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Country | US
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Telephone | 510-502-3280
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Fax | 510-868-1940
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Provider Business Mailing Address
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Address Line | 2600 SAN LEANDRO BLVD APT 1319
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City | SAN LEANDRO
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State | CA
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Zip | 94578-5048
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Country | US
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Telephone | 831-600-5175
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Fax | 510-868-1940
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW76919
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License Number State | CA
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