Healthcare Provider Details

I. General information

NPI: 1861236556
Provider Name (Legal Business Name): ALESSANDRO HURTADO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2024
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 NW 87TH AVE STE 22
DORAL FL
33172-1619
US

IV. Provider business mailing address

10341 SW 145TH PL
MIAMI FL
33186-6940
US

V. Phone/Fax

Practice location:
  • Phone: 305-592-5555
  • Fax:
Mailing address:
  • Phone: 786-436-0825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number42126
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: