Healthcare Provider Details

I. General information

NPI: 1639324148
Provider Name (Legal Business Name): DAVID DWIGHT HURTADO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2008
Last Update Date: 11/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 MERTON MINTER ST
SAN ANTONIO TX
78229-4404
US

IV. Provider business mailing address

7400 MERTON MINTER ST
SAN ANTONIO TX
78229-4404
US

V. Phone/Fax

Practice location:
  • Phone: 210-617-5300
  • Fax: 210-617-5201
Mailing address:
  • Phone: 210-617-5300
  • Fax: 210-617-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number586
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: