Basic Information
| Provider Information | |||||||||
| NPI: | 1528613544 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HURTADO | ||||||||
| FirstName: | CESAR | ||||||||
| MiddleName: | OCTAVIO | ||||||||
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| Credential: | AMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7121 PARK MANOR AVE | ||||||||
| Address2: | |||||||||
| City: | NORTH HOLLYWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 916054414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8182546727 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8330 RESEDA BLVD | ||||||||
| Address2: | |||||||||
| City: | NORTHRIDGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913244619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189961051 | ||||||||
| FaxNumber: | 8189755072 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2019 | ||||||||
| LastUpdateDate: | 08/06/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | AMFT113092 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.