Healthcare Provider Details

I. General information

NPI: 1619636859
Provider Name (Legal Business Name): CARLOS RAUL HURTADO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2021
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 EUCLID ST NW APT 403
WASHINGTON DC
20009-2875
US

IV. Provider business mailing address

3106 MONROE ST NE
WASHINGTON DC
20018-4020
US

V. Phone/Fax

Practice location:
  • Phone: 202-826-0874
  • Fax:
Mailing address:
  • Phone: 202-989-9883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: