Healthcare Provider Details

I. General information

NPI: 1417958166
Provider Name (Legal Business Name): ANDREINA F HURTADO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 NW 179TH AVE SUITE 202
PEMBROKE PINES FL
33029-2818
US

IV. Provider business mailing address

302 NW 179TH AVE SUITE 202
PEMBROKE PINES FL
33029-2818
US

V. Phone/Fax

Practice location:
  • Phone: 954-433-5152
  • Fax: 954-433-5114
Mailing address:
  • Phone: 954-433-5152
  • Fax: 954-433-5114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME84373
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: