Active NPI
Elie Hurtado
- Community Health Worker
- San Bernardino, CA
National Provider Identifier
1104950567
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Health Worker
- Practice address
- 572 N Arrowhead Ave
San Bernardino, CA 92401-1251 - Phone
- (408) 364-4004
- NPI assigned
- Mar 15, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Worker | 172V00000X | Primary |
Addresses
Primary practice location
572 N Arrowhead Ave
San Bernardino, CA 92401-1251
Mailing address
572 N Arrowhead Ave
San Bernardino, CA 92401-1251
Phone (909) 640-0814
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ICAN760 | Other | CA | LADMH STAFF CODE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173916800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1698796800000",
"number": "1104950567",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "572 N ARROWHEAD AVE",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924011251",
"telephone_number": "909-640-0814"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "572 N ARROWHEAD AVE",
"city": "SAN BERNARDINO",
"state": "CA",
"postal_code": "924011251",
"telephone_number": "408-364-4004"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HURTADO",
"first_name": "ELIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-15",
"last_updated": "2023-11-01",
"certification_date": "2023-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "172V00000X",
"taxonomy_group": "",
"desc": "Community Health Worker",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LADMH STAFF CODE",
"identifier": "ICAN760",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Bernardino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.