Healthcare Provider Details

I. General information

NPI: 1326357286
Provider Name (Legal Business Name): CARLOS HURTADO INFANTE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2010
Last Update Date: 10/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

383 W 34TH ST
HIALEAH FL
33012-4309
US

IV. Provider business mailing address

167 W 23RD ST
HIALEAH FL
33010-2211
US

V. Phone/Fax

Practice location:
  • Phone: 305-884-1744
  • Fax: 305-884-3989
Mailing address:
  • Phone: 305-823-8812
  • Fax: 305-884-3989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME114897
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: