Healthcare Provider Details

I. General information

NPI: 1457609422
Provider Name (Legal Business Name): MARGEAUX HURTADO MA CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2012
Last Update Date: 08/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 EOTOTO RD
EL PRADO NM
87529-7439
US

IV. Provider business mailing address

51 EOTOTO RD
EL PRADO NM
87529-7439
US

V. Phone/Fax

Practice location:
  • Phone: 575-758-8339
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4179
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: