Provider Demographics
NPI:1982786752
Name:HURD, PRITI PATEL (PA)
Entity Type:Individual
Prefix:
First Name:PRITI
Middle Name:PATEL
Last Name:HURD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 55323
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91413-0323
Mailing Address - Country:US
Mailing Address - Phone:402-715-4467
Mailing Address - Fax:
Practice Address - Street 1:1328 22ND ST
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2032
Practice Address - Country:US
Practice Address - Phone:310-582-7089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005031147363AM0700X
KS1501035363AM0700X
CA19770363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical