Provider Demographics
NPI:1538032453
Name:HURTADO, GERALDINE (PHI)
Entity type:Individual
Prefix:MRS
First Name:GERALDINE
Middle Name:
Last Name:HURTADO
Suffix:
Gender:F
Credentials:PHI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 SAN LEANDRO BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-1595
Mailing Address - Country:US
Mailing Address - Phone:510-913-0166
Mailing Address - Fax:510-268-2036
Practice Address - Street 1:1100 SAN LEANDRO BLVD
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-1595
Practice Address - Country:US
Practice Address - Phone:510-913-0166
Practice Address - Fax:510-268-2036
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-26
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker