Healthcare Provider Details

I. General information

NPI: 1043039613
Provider Name (Legal Business Name): ALEJANDRO HURTADO III RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 FISHERMAN LN
GREENVILLE SC
29615-5013
US

IV. Provider business mailing address

116 PINE TREE RD
INMAN SC
29349-6227
US

V. Phone/Fax

Practice location:
  • Phone: 855-390-6568
  • Fax:
Mailing address:
  • Phone: 828-318-6510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number269351
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: