1336157379 NPI number — DR. SUSAN I HURST PHD

Table of content: DR. SUSAN I HURST PHD (NPI 1336157379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336157379 NPI number — DR. SUSAN I HURST PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HURST
Provider First Name:
SUSAN
Provider Middle Name:
I
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336157379
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
636 EDGEWOOD LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANGELS CAMP
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95222-8212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-990-9525
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
245 TOM BELL RD
Provider Second Line Business Practice Location Address:
STE C
Provider Business Practice Location Address City Name:
MURPHYS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95247-9585
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-993-1664
Provider Business Practice Location Address Fax Number:
714-993-1079
Provider Enumeration Date:
08/04/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC19508 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: PSY14337 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)