Provider Demographics
NPI:1225735509
Name:HURTADO, ETHAN P
Entity Type:Individual
Prefix:
First Name:ETHAN
Middle Name:P
Last Name:HURTADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18001 MANZANITA ST
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-4925
Mailing Address - Country:US
Mailing Address - Phone:626-362-6168
Mailing Address - Fax:
Practice Address - Street 1:3333 CONCOURS STE 4102
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-6564
Practice Address - Country:US
Practice Address - Phone:909-240-1764
Practice Address - Fax:909-259-2369
Is Sole Proprietor?:No
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician