Provider Demographics
NPI:1881635191
Name:HURTADO, ALFREDO WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFREDO
Middle Name:WILLIAM
Last Name:HURTADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 HARRISON PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2853
Mailing Address - Country:US
Mailing Address - Phone:800-437-2672
Mailing Address - Fax:954-514-3919
Practice Address - Street 1:1613 HARRISON PKWY STE 200
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-2853
Practice Address - Country:US
Practice Address - Phone:800-437-2672
Practice Address - Fax:954-514-3919
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA878762085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A878760OtherBS
CA00A878760Medicaid
CA00A878761Medicare PIN
CA00A878760OtherBS
CA00A878760Medicaid