Provider Demographics
NPI:1619445954
Name:HURTADO, RICARDO (SAC)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:HURTADO
Suffix:
Gender:M
Credentials:SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 S ORANGE AVE STE 601
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2153
Mailing Address - Country:US
Mailing Address - Phone:407-649-1097
Mailing Address - Fax:407-841-3786
Practice Address - Street 1:1405 S ORANGE AVE STE 601
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2153
Practice Address - Country:US
Practice Address - Phone:407-649-1097
Practice Address - Fax:407-841-3786
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant