MEDICARE: MARGEAUX HURTADO MA CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	4179	NM

General Provider Information

NPI Number	:	1457609422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGEAUX HURTADO MA CCC-SLP

Provider Business Mailing Address
First Line	:	51 EOTOTO RD
Second Line	:
City	:	EL PRADO
State	:	NM
Zip	:	87529-7439
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	51 EOTOTO RD
Second Line	:
City	:	EL PRADO
State	:	NM
Zip	:	87529-7439
Country	:	US
Telephone Number	:	575-758-8339
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2012
Last Update Date	:	08/24/2012

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Directions to “ MARGEAUX HURTADO MA CCC-SLP” Practice Location

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