1417958166 NPI number — ANDREINA F HURTADO MD

Table of content: ANDREINA F HURTADO MD (NPI 1417958166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417958166 NPI number — ANDREINA F HURTADO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HURTADO
Provider First Name:
ANDREINA
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417958166
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
302 NW 179TH AVE
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
PEMBROKE PINES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33029-2818
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-433-5152
Provider Business Mailing Address Fax Number:
954-433-5114

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
302 NW 179TH AVE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
PEMBROKE PINES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33029-2818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-433-5152
Provider Business Practice Location Address Fax Number:
954-433-5114
Provider Enumeration Date:
08/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  ME84373 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 33512312 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 01579 . This is a "BLUE CTROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 4320 . This is a "TOTAL HEALTH CHOICE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 11213201 . This is a "CITRUS HEALTH CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 46513 . This is a "SPECTA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 56223 . This is a "NHP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 224581 . This is a "EYE MED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 300124 . This is a "AV MED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7280759 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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