Healthcare Provider Details

I. General information

NPI: 1275840951
Provider Name (Legal Business Name): IDANIA HURTADO-PEREZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2010
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16239 SW 88TH ST
MIAMI FL
33196-4912
US

IV. Provider business mailing address

16239 SW 88TH ST
MIAMI FL
33196-4912
US

V. Phone/Fax

Practice location:
  • Phone: 786-953-5009
  • Fax: 786-485-3914
Mailing address:
  • Phone: 786-953-5009
  • Fax: 786-485-3914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME116576
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: