Provider Demographics
NPI:1073211264
Name:HURST, BENJAMIN (MBA)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:HURST
Suffix:
Gender:M
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 PIONEER RD
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-1418
Mailing Address - Country:US
Mailing Address - Phone:714-210-6037
Mailing Address - Fax:
Practice Address - Street 1:10200 PIONEER RD
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-1418
Practice Address - Country:US
Practice Address - Phone:714-210-6037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker