Healthcare Provider Details

I. General information

NPI: 1639405376
Provider Name (Legal Business Name): LIZA HURTADO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2009
Last Update Date: 10/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 RIVERSIDE DR
UVALDE TX
78801-5727
US

IV. Provider business mailing address

133 WILLIAM ST
UVALDE TX
78801-4044
US

V. Phone/Fax

Practice location:
  • Phone: 830-278-6681
  • Fax:
Mailing address:
  • Phone: 830-486-7472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number648915
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: