Healthcare Provider Details

I. General information

NPI: 1851704621
Provider Name (Legal Business Name): FABIOLA HURTADO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14515 BRIARHILLS PKWY #208
HOUSTON TX
77077-1000
US

IV. Provider business mailing address

12501 BROADWAY ST
PEARLAND TX
77584-8999
US

V. Phone/Fax

Practice location:
  • Phone: 713-575-2000
  • Fax:
Mailing address:
  • Phone: 956-740-2818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number36863
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: