Provider Demographics
NPI:1427525922
Name:SHELLEY HURGUY INC
Entity type:Organization
Organization Name:SHELLEY HURGUY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HURGUY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:323-376-6121
Mailing Address - Street 1:PO BOX 7032
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93006-7032
Mailing Address - Country:US
Mailing Address - Phone:323-376-6121
Mailing Address - Fax:
Practice Address - Street 1:325 ROLLING OAKS DR STE 110
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1299
Practice Address - Country:US
Practice Address - Phone:909-946-5752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty