MEDICARE: MRS. MARICELA HURTADO LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	48616	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	48616	OTHER	CA	BOARD OF BEHAVIORAL SCIENCES

General Provider Information

NPI Number	:	1760522775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARICELA HURTADO LMFT

Provider Business Mailing Address
First Line	:	1531 FAIRFIELD ST
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91201-2739
Country	:	US
Telephone Number	:	805-709-4281
Fax Number	:

Provider Business Practice Location Address
First Line	:	4405 W RIVERSIDE DR STE 205B
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-4050
Country	:	US
Telephone Number	:	805-709-4281
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	01/25/2019

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