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General NPI Number Information
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NPI Number | 1659945863
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Entity Type | Organization
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Legal Business Name | HURTT FAMILY HEALTH CLINIC INC.
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Dates
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Enumeration Date | 05/13/2021
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Last Update Date | 05/13/2021
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Provider Practice Location Address
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Address Line | 14642 NEWPORT AVE STE 200
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City | TUSTIN
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State | CA
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Zip | 92780-6058
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Country | US
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Telephone | 714-247-0300
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Fax |
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Provider Business Mailing Address
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Address Line | 14642 NEWPORT AVE STE 300
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City | TUSTIN
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State | CA
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Zip | 92780-6059
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Country | US
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Telephone | 714-247-0300
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | BECKY CARTER
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Credential |
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Telephone | 714-247-4304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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