Healthcare Provider Details

I. General information

NPI: 1124020367
Provider Name (Legal Business Name): SANDRA M HURTADO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 GESSNER RD STE 575
HOUSTON TX
77024-2552
US

IV. Provider business mailing address

929 GESSNER RD STE 1300
HOUSTON TX
77024-2469
US

V. Phone/Fax

Practice location:
  • Phone: 713-486-6640
  • Fax: 713-827-7752
Mailing address:
  • Phone: 713-486-6600
  • Fax: 713-465-1233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberL2332
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: