Healthcare Provider Details

I. General information

NPI: 1154798627
Provider Name (Legal Business Name): MR. RIGOBERTO HURTADO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2015
Last Update Date: 08/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 E MAIN ST
EAGLE PASS TX
78852-4696
US

IV. Provider business mailing address

1204 E MAIN ST
EAGLE PASS TX
78852-4696
US

V. Phone/Fax

Practice location:
  • Phone: 830-776-5002
  • Fax: 830-776-5371
Mailing address:
  • Phone: 830-776-5002
  • Fax: 830-776-5371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: