Healthcare Provider Details

I. General information

NPI: 1073019865
Provider Name (Legal Business Name): GILBERTO HURTADO PEREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18645 SW 291ST ST
HOMESTEAD FL
33030-3056
US

IV. Provider business mailing address

2724 LINCOLN ST
HOLLYWOOD FL
33020-3846
US

V. Phone/Fax

Practice location:
  • Phone: 786-580-9262
  • Fax:
Mailing address:
  • Phone: 786-580-9262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-57311
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: