Individual
ANGELICA HURTADO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2085 RUSTIN AVE, RIVERSIDE, CA 92507-2498
(951) 358-4625
Mailing address
2085 RUSTIN AVE., RIVERSIDE, CA 92507
(951) 955-7263
(951) 955-7205
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
333312475507
MEDI-CAL CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES
CA
Enumeration date
06/20/2017
Last updated
09/07/2017
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