Provider Demographics
NPI:1407890049
Name:HURTADO, WALTER SAMUEL (PA C)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:SAMUEL
Last Name:HURTADO
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1377 E HERNDON AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3022
Mailing Address - Country:US
Mailing Address - Phone:559-450-7455
Mailing Address - Fax:559-450-7473
Practice Address - Street 1:1377 E HERNDON AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3022
Practice Address - Country:US
Practice Address - Phone:559-450-7455
Practice Address - Fax:559-450-7473
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA16233363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical