Provider Demographics
NPI:1306482682
Name:HURTADO, MARIBEL (DACM, LAC)
Entity type:Individual
Prefix:DR
First Name:MARIBEL
Middle Name:
Last Name:HURTADO
Suffix:
Gender:F
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 LAS FLORES DR
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-1966
Mailing Address - Country:US
Mailing Address - Phone:619-882-4260
Mailing Address - Fax:
Practice Address - Street 1:66 LAS FLORES DR
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-1966
Practice Address - Country:US
Practice Address - Phone:619-882-4260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18420171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist