Healthcare Provider Details

I. General information

NPI: 1619445954
Provider Name (Legal Business Name): RICARDO HURTADO SAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 S ORANGE AVE STE 601
ORLANDO FL
32806-2153
US

IV. Provider business mailing address

1405 S ORANGE AVE STE 601
ORLANDO FL
32806-2153
US

V. Phone/Fax

Practice location:
  • Phone: 407-649-1097
  • Fax: 407-841-3786
Mailing address:
  • Phone: 407-649-1097
  • Fax: 407-841-3786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: