Healthcare Provider Details

I. General information

NPI: 1841578242
Provider Name (Legal Business Name): GABRIEL ALEXANDER HURTADO GOMEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 LUCERNE TER
ORLANDO FL
32806-1015
US

IV. Provider business mailing address

1012 LUCERNE TER
ORLANDO FL
32806-1015
US

V. Phone/Fax

Practice location:
  • Phone: 407-423-1039
  • Fax: 407-425-2347
Mailing address:
  • Phone: 407-423-1039
  • Fax: 407-425-2347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number24097
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME147533
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: