1770674574 NPI number — ANDREINA F HURTADO MD PA

Table of content: (NPI 1770674574)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770674574 NPI number — ANDREINA F HURTADO MD PA

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
PINES OPHTHALMOLOGY CARE
Provider Other Organization Name Type Code:
3
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:
1770674574
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
302 NW 179 AVENUE
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
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-433-5152
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
302 NW 179 AVENUE
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
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:
Provider Enumeration Date:
09/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HURTADO
Authorized Official First Name:
ANDREINA
Authorized Official Middle Name:
F
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
954-433-5152

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 11213201 . This is a "CITRUS HEALTH CARE" 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: 728759 . This is a "AETNA" 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: 4320 . This is a "TOTAL HEALTH CHOICE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 46513 . This is a "SPECTRA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 300124 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 017071400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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