Provider Demographics
NPI:1124020367
Name:HURTADO, SANDRA M (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:M
Last Name:HURTADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 GESSNER RD STE 1300
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2469
Mailing Address - Country:US
Mailing Address - Phone:713-486-6600
Mailing Address - Fax:713-465-1233
Practice Address - Street 1:925 GESSNER RD STE 575
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2552
Practice Address - Country:US
Practice Address - Phone:713-486-6640
Practice Address - Fax:713-827-7752
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2332207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A6813OtherBLUE CROSS & BLUE SHIELD
TX1523375-01Medicaid
TX8A6813OtherBLUE CROSS & BLUE SHIELD
TX8003N5Medicare ID - Type UnspecifiedHARRIS COUNTY
TXG00615Medicare UPIN