Healthcare Provider Details

I. General information

NPI: 1528243243
Provider Name (Legal Business Name): J. DAVID HURTADO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 01/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 N 18TH ST STE 402
PHOENIX AZ
85006-3746
US

IV. Provider business mailing address

525 N 18TH ST STE 402
PHOENIX AZ
85006-3746
US

V. Phone/Fax

Practice location:
  • Phone: 602-253-2813
  • Fax: 602-253-2815
Mailing address:
  • Phone: 602-253-2813
  • Fax: 602-253-2815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21035
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: