Provider Demographics
NPI:1962908350
Name:HURTADO, DAMARYS
Entity type:Individual
Prefix:
First Name:DAMARYS
Middle Name:
Last Name:HURTADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5430 W 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2542
Mailing Address - Country:US
Mailing Address - Phone:305-490-5868
Mailing Address - Fax:305-742-2190
Practice Address - Street 1:5430 W 6TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2542
Practice Address - Country:US
Practice Address - Phone:305-490-5868
Practice Address - Fax:305-742-2190
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician