Healthcare Provider Details

I. General information

NPI: 1003410267
Provider Name (Legal Business Name): MARIA ANGELICA HURTADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2020
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 WILLIAM ST FL 19
NEW YORK NY
10038-3937
US

IV. Provider business mailing address

110 WILLIAM ST FL 19
NEW YORK NY
10038-3937
US

V. Phone/Fax

Practice location:
  • Phone: 516-986-8085
  • Fax:
Mailing address:
  • Phone: 516-986-8085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number006823-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: