Healthcare Provider Details

I. General information

NPI: 1346355096
Provider Name (Legal Business Name): CUAUHTEMOC HURTADO M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 09/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 MCKINLEY AVE
EL PASO TX
79930-2240
US

IV. Provider business mailing address

2300 MCKINLEY AVE
EL PASO TX
79930-2240
US

V. Phone/Fax

Practice location:
  • Phone: 915-562-3444
  • Fax: 915-875-8854
Mailing address:
  • Phone: 915-562-3444
  • Fax: 915-875-8854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberN3743
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: