Healthcare Provider Details

I. General information

NPI: 1376072447
Provider Name (Legal Business Name): LYNZEE HURTADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2017
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1332 SW 151ST AVE
SUNRISE FL
33326-1925
US

IV. Provider business mailing address

1332 SW 151ST AVE
SUNRISE FL
33326-1925
US

V. Phone/Fax

Practice location:
  • Phone: 954-347-0259
  • Fax:
Mailing address:
  • Phone: 954-347-0259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-39582
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: