Individual
TERESA BAUTISTA HURTADO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CLS/MLT
Contact information
Practice address
505 PENOBSCOT DR, REDWOOD CITY, CA 94063-4737
(855) 698-8887
Mailing address
33527 4TH ST, UNION CITY, CA 94587-2412
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
MTA-02044844
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25707877
ASCP
CA
01
—
MTA-02044844
CALIFORNIA DEPARTMENT OF PUBLIC HEALTH
CA
Enumeration date
05/26/2020
Last updated
05/26/2020
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