Healthcare Provider Details

I. General information

NPI: 1881635191
Provider Name (Legal Business Name): ALFREDO WILLIAM HURTADO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 HARRISON PKWY STE 200
SUNRISE FL
33323-2853
US

IV. Provider business mailing address

1613 HARRISON PKWY STE 200
SUNRISE FL
33323-2853
US

V. Phone/Fax

Practice location:
  • Phone: 800-437-2672
  • Fax: 954-514-3919
Mailing address:
  • Phone: 800-437-2672
  • Fax: 954-514-3919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA87876
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: