Healthcare Provider Details

I. General information

NPI: 1306203385
Provider Name (Legal Business Name): STEVEN HURTADO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2016
Last Update Date: 04/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5776 SAINT AUGUSTINE RD
JACKSONVILLE FL
32207-8030
US

IV. Provider business mailing address

5776 SAINT AUGUSTINE RD
JACKSONVILLE FL
32207-8030
US

V. Phone/Fax

Practice location:
  • Phone: 904-448-4700
  • Fax: 904-448-4717
Mailing address:
  • Phone: 904-448-4700
  • Fax: 904-448-4717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: