Provider Demographics
NPI:1891003869
Name:ANTONIO HURTADO RODRIGUEZ M.D., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ANTONIO HURTADO RODRIGUEZ M.D., A PROFESSIONAL CORPORATION
Other - Org Name:ANTONIO HURTADO RODRIGUEZ, M.D., A PROFESSIONAL CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:HURTADO
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-622-3700
Mailing Address - Street 1:630 N PARK AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91768-3621
Mailing Address - Country:US
Mailing Address - Phone:909-622-3700
Mailing Address - Fax:909-622-3744
Practice Address - Street 1:630 N PARK AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768-3621
Practice Address - Country:US
Practice Address - Phone:909-622-3700
Practice Address - Fax:909-622-3744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2020-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA109646261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care