Individual
ALISSA RENEE HURTADO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3436 ISLETA BLVD SW, ALBUQUERQUE, NM 87105-5837
(505) 596-2300
Mailing address
PO BOX 26666, PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2021-0069
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/18/2020
Last updated
09/09/2021
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