Healthcare Provider Details

I. General information

NPI: 1861210932
Provider Name (Legal Business Name): HECTOR HURTADO HERRERA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2024
Last Update Date: 09/28/2024
Certification Date: 09/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SW 120TH AVE
MIAMI FL
33184-1643
US

IV. Provider business mailing address

500 SW 120TH AVE
MIAMI FL
33184-1643
US

V. Phone/Fax

Practice location:
  • Phone: 305-726-7646
  • Fax:
Mailing address:
  • Phone: 305-726-7646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-374361
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: