Provider Demographics
NPI:1417958166
Name:HURTADO, ANDREINA F (MD)
Entity Type:Individual
Prefix:
First Name:ANDREINA
Middle Name:F
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 1:302 NW 179TH AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2818
Mailing Address - Country:US
Mailing Address - Phone:954-433-5152
Mailing Address - Fax:954-433-5114
Practice Address - Street 1:302 NW 179TH AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2818
Practice Address - Country:US
Practice Address - Phone:954-433-5152
Practice Address - Fax:954-433-5114
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84373207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL33512312OtherCIGNA
FL01579OtherBLUE CTROSS BLUE SHIELD
FL4320OtherTOTAL HEALTH CHOICE
FL11213201OtherCITRUS HEALTH CARE
FL46513OtherSPECTA
FL56223OtherNHP
FL224581OtherEYE MED
FL300124OtherAV MED
FL7280759OtherAETNA
H85820Medicare UPIN
FL33512312OtherCIGNA