Provider Demographics
NPI:1467198838
Name:HURTADO, ANGELA MERCEDES
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MERCEDES
Last Name:HURTADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9656 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-2325
Mailing Address - Country:US
Mailing Address - Phone:916-212-8864
Mailing Address - Fax:
Practice Address - Street 1:2230 LONGPORT CT STE 130
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-7182
Practice Address - Country:US
Practice Address - Phone:916-224-1666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician