Provider Demographics
NPI:1467087924
Name:OCHOTECO HURTADO, JOSE C SR
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:C
Last Name:OCHOTECO HURTADO
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 NW 171ST AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PNES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1922
Mailing Address - Country:US
Mailing Address - Phone:315-240-3744
Mailing Address - Fax:
Practice Address - Street 1:1750 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-8903
Practice Address - Country:US
Practice Address - Phone:754-529-8242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-20-41736103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst