Healthcare Provider Details

I. General information

NPI: 1245880285
Provider Name (Legal Business Name): VERONICA MARCELA HURTADO URIBE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 SW 124TH TER APT Q414
PEMBROKE PINES FL
33027-7144
US

IV. Provider business mailing address

1400 SW 124TH TER APT Q414
PEMBROKE PINES FL
33027-7144
US

V. Phone/Fax

Practice location:
  • Phone: 786-617-0681
  • Fax:
Mailing address:
  • Phone: 786-617-0681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberH633-873-89-769-0
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: