Healthcare Provider Details
I. General information
NPI: 1790786044
Provider Name (Legal Business Name): CHERYL L. HURTADO ACNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 08/09/2005
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:
III. Provider practice location address
900 W. 38TH STREET, SUITE 110
AUSTIN TX
78705
US
IV. Provider business mailing address
900 W. 38TH STREET, SUITE 110
AUSTIN TX
78705
US
V. Phone/Fax
- Phone: 512-421-3869
- Fax: 512-407-1873
- Phone: 512-421-3869
- Fax: 512-407-1873
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207RC0000X |
| Taxonomy | Cardiovascular Disease Physician |
| License Number | 630423 |
| License Number State | TX |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 364SA2200X |
| Taxonomy | Adult Health Clinical Nurse Specialist |
| License Number | 630423 |
| License Number State | TX |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: