Healthcare Provider Details

I. General information

NPI: 1528796711
Provider Name (Legal Business Name): ALONDRA HURTADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 ARBOR DR
SOUTH SIOUX CITY NE
68776-2472
US

IV. Provider business mailing address

820 E 29TH ST
SOUTH SIOUX CITY NE
68776-3344
US

V. Phone/Fax

Practice location:
  • Phone: 402-494-1446
  • Fax:
Mailing address:
  • Phone: 402-494-0106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: