Healthcare Provider Details

I. General information

NPI: 1063322006
Provider Name (Legal Business Name): VIVIAN M HURTADO OQUENDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8713 SW 147TH PL
MIAMI FL
33193-1542
US

IV. Provider business mailing address

8713 SW 147TH PL
MIAMI FL
33193-1542
US

V. Phone/Fax

Practice location:
  • Phone: 786-250-8204
  • Fax:
Mailing address:
  • Phone: 786-250-8204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11050512
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: