Healthcare Provider Details

I. General information

NPI: 1740326123
Provider Name (Legal Business Name): RAFAEL V HURTADO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 EXECUTIVE DR
DANVILLE VA
24541-4100
US

IV. Provider business mailing address

178 EXECUTIVE DR
DANVILLE VA
24541-4100
US

V. Phone/Fax

Practice location:
  • Phone: 434-792-3232
  • Fax: 434-792-3236
Mailing address:
  • Phone: 434-792-3232
  • Fax: 434-792-3236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0101238333
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: