Healthcare Provider Details

I. General information

NPI: 1134900707
Provider Name (Legal Business Name): ALYSSA MARIA HURTADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2023
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 N UNIVERSITY DR
PLANTATION FL
33324-2002
US

IV. Provider business mailing address

261 N UNIVERSITY DR
PLANTATION FL
33324-2002
US

V. Phone/Fax

Practice location:
  • Phone: 954-931-1803
  • Fax: 888-320-6434
Mailing address:
  • Phone: 954-931-1803
  • Fax: 888-320-6434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-477320
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: