MEDICARE: TYFFANY SEBASTIAN HURTADO MD

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	390200000X	Student in an Organized Health Care Education/Training Program	35776-R	PR
2	207R00000X	Internal Medicine Physician	23835	PR

General Provider Information

NPI Number	:	1760153068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYFFANY SEBASTIAN HURTADO MD

Provider Business Mailing Address
First Line	:	4021 CALLE EL ANAEZ
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00728-2033
Country	:	US
Telephone Number	:	787-981-9855
Fax Number	:

Provider Business Practice Location Address
First Line	:	4021 CALLE EL ANAEZ
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00728-2033
Country	:	US
Telephone Number	:	787-981-9855
Fax Number	:

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

Provider Enumeration Date	:	09/26/2021
Last Update Date	:	08/28/2025

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