Healthcare Provider Details

I. General information

NPI: 1295435733
Provider Name (Legal Business Name): SALIM HURTADO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2023
Last Update Date: 03/03/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9550 W SAHARA AVE
LAS VEGAS NV
89117-5373
US

IV. Provider business mailing address

9550 W SAHARA AVE APT 2007
LAS VEGAS NV
89117-5383
US

V. Phone/Fax

Practice location:
  • Phone: 480-233-8422
  • Fax:
Mailing address:
  • Phone: 480-233-8422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: