Provider Demographics
NPI:1710268644
Name:HURR, LOIS CHI-MAY
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:CHI-MAY
Last Name:HURR
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 1:12386 MONTAUK WAY
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95742-7725
Mailing Address - Country:US
Mailing Address - Phone:916-801-5356
Mailing Address - Fax:
Practice Address - Street 1:12386 MONTAUK WAY
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95742-7725
Practice Address - Country:US
Practice Address - Phone:916-801-5356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102981390200000X
CA27938390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program