Healthcare Provider Details

I. General information

NPI: 1073376232
Provider Name (Legal Business Name): RICARDO XAVIER HURTADO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2024
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 W HOLLADAY DR
TUCSON AZ
85706-3265
US

IV. Provider business mailing address

509 W HOLLADAY DR
TUCSON AZ
85706-3265
US

V. Phone/Fax

Practice location:
  • Phone: 520-971-2702
  • Fax:
Mailing address:
  • Phone: 520-971-2702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number13329
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: