MEDICARE: DR. ALEJANDRO HURTADO D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	37118	CA

General Provider Information

NPI Number	:	1427050236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEJANDRO HURTADO D.D.S.

Provider Business Mailing Address
First Line	:	115 S LOS ROBLES AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-2417
Country	:	US
Telephone Number	:	626-440-1700
Fax Number	:	626-585-1742

Provider Business Practice Location Address
First Line	:	115 S LOS ROBLES AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-2417
Country	:	US
Telephone Number	:	626-795-8628
Fax Number	:	626-585-1742

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	08/06/2015

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