Provider Demographics
NPI:1487399986
Name:HURLEY, WILBUR III
Entity type:Individual
Prefix:
First Name:WILBUR
Middle Name:
Last Name:HURLEY
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-2515
Mailing Address - Country:US
Mailing Address - Phone:760-521-8891
Mailing Address - Fax:
Practice Address - Street 1:1023 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-2515
Practice Address - Country:US
Practice Address - Phone:760-521-8891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-29
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty