Healthcare Provider Details

I. General information

NPI: 1629750559
Provider Name (Legal Business Name): IVETTE HURTADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 WYCKOFF AVE
BROOKLYN NY
11237-5384
US

IV. Provider business mailing address

11814 83RD AVE APT 6J
KEW GARDENS NY
11415-1308
US

V. Phone/Fax

Practice location:
  • Phone: 719-497-6090
  • Fax:
Mailing address:
  • Phone: 929-453-8784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberP123390
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: