Healthcare Provider Details

I. General information

NPI: 1649016577
Provider Name (Legal Business Name): MANUELA HURTADO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2776 W 69TH TER
HIALEAH FL
33016-5484
US

IV. Provider business mailing address

2776 W 69TH TER
HIALEAH FL
33016-5484
US

V. Phone/Fax

Practice location:
  • Phone: 305-607-0923
  • Fax:
Mailing address:
  • Phone: 305-607-0923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN29090
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: