Healthcare Provider Details

I. General information

NPI: 1851802326
Provider Name (Legal Business Name): JOHN C HURTADO JR. COTA/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 10/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 TRAMWAY RD
SANFORD NC
27332-7142
US

IV. Provider business mailing address

145 SORGHUM WAY
FAYETTEVILLE NC
28314-1320
US

V. Phone/Fax

Practice location:
  • Phone: 919-775-5404
  • Fax:
Mailing address:
  • Phone: 910-231-2392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number7927
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: