Provider Demographics
NPI:1003410267
Name:HURTADO, MARIA ANGELICA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ANGELICA
Last Name:HURTADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 WILLIAM ST FL 19
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-3937
Mailing Address - Country:US
Mailing Address - Phone:516-986-8085
Mailing Address - Fax:
Practice Address - Street 1:110 WILLIAM ST FL 19
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-3937
Practice Address - Country:US
Practice Address - Phone:516-986-8085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-27
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006823-01171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist