Provider Demographics
NPI:1932390374
Name:HURTADO, REBECA MARCELA (MSW)
Entity Type:Individual
Prefix:MRS
First Name:REBECA
Middle Name:MARCELA
Last Name:HURTADO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 S GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-4141
Mailing Address - Country:US
Mailing Address - Phone:626-691-1857
Mailing Address - Fax:626-691-1178
Practice Address - Street 1:725 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-4141
Practice Address - Country:US
Practice Address - Phone:626-691-1857
Practice Address - Fax:626-691-1178
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS28276OtherLCSW