Provider Demographics
NPI:1962595611
Name:HURRAY, ALVIE S (DPM)
Entity type:Individual
Prefix:
First Name:ALVIE
Middle Name:S
Last Name:HURRAY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 VIA VAQUERO SUR
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN BAUTISTA
Mailing Address - State:CA
Mailing Address - Zip Code:95045
Mailing Address - Country:US
Mailing Address - Phone:831-623-9292
Mailing Address - Fax:
Practice Address - Street 1:9029 SOQUEL AVE
Practice Address - Street 2:SUITE D
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2085
Practice Address - Country:US
Practice Address - Phone:831-479-8310
Practice Address - Fax:831-479-8318
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2399213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA942612498OtherTAX ID
CA000E23990Medicaid
CAT11309Medicare UPIN
CA000E23990Medicare ID - Type Unspecified
CA6650440001Medicare NSC