Healthcare Provider Details

I. General information

NPI: 1427050236
Provider Name (Legal Business Name): ALEJANDRO HURTADO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 08/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 S LOS ROBLES AVE
PASADENA CA
91101-2417
US

IV. Provider business mailing address

115 S LOS ROBLES AVE
PASADENA CA
91101-2417
US

V. Phone/Fax

Practice location:
  • Phone: 626-795-8628
  • Fax: 626-585-1742
Mailing address:
  • Phone: 626-440-1700
  • Fax: 626-585-1742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number37118
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: