Healthcare Provider Details

I. General information

NPI: 1609206358
Provider Name (Legal Business Name): MARIANA HURTADO-SBORDONI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2013
Last Update Date: 03/13/2020
Certification Date: 03/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9090 KATY FWY STE 200
HOUSTON TX
77024-1696
US

IV. Provider business mailing address

9090 KATY FWY STE 200
HOUSTON TX
77024-1696
US

V. Phone/Fax

Practice location:
  • Phone: 832-522-8720
  • Fax:
Mailing address:
  • Phone: 832-522-8720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number283076
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR0588
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: