MEDICARE: RICARDO HURTADO SAC

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	246ZC0007X	Surgical Assistant

General Provider Information

NPI Number	:	1619445954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICARDO HURTADO SAC

Provider Business Mailing Address
First Line	:	1405 S ORANGE AVE STE 601
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32806-2153
Country	:	US
Telephone Number	:	407-649-1097
Fax Number	:	407-841-3786

Provider Business Practice Location Address
First Line	:	1405 S ORANGE AVE STE 601
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32806-2153
Country	:	US
Telephone Number	:	407-649-1097
Fax Number	:	407-841-3786

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

Provider Enumeration Date	:	11/05/2018
Last Update Date	:	11/05/2018

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Directions to “ RICARDO HURTADO SAC” Practice Location

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