Provider Demographics
NPI:1720735681
Name:HURTADO, NOEMI (LPT)
Entity Type:Individual
Prefix:MS
First Name:NOEMI
Middle Name:
Last Name:HURTADO
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 W CENTURY BLVD
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-6601
Mailing Address - Country:US
Mailing Address - Phone:209-395-6048
Mailing Address - Fax:
Practice Address - Street 1:515 W CENTURY BLVD
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-6601
Practice Address - Country:US
Practice Address - Phone:209-395-6048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41803167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician