Healthcare Provider Details

I. General information

NPI: 1164996716
Provider Name (Legal Business Name): INGRID HURTADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 01/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7851 NW 159TH TER
MIAMI LAKES FL
33016-6680
US

IV. Provider business mailing address

7851 NW 159TH TER
MIAMI LAKES FL
33016-6680
US

V. Phone/Fax

Practice location:
  • Phone: 772-361-8581
  • Fax:
Mailing address:
  • Phone: 772-361-8581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number18-72944
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: