Provider Demographics
NPI:1760153068
Name:SEBASTIAN HURTADO, TYFFANY (MD)
Entity type:Individual
Prefix:
First Name:TYFFANY
Middle Name:
Last Name:SEBASTIAN HURTADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4021 CALLE EL ANAEZ
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-2033
Mailing Address - Country:US
Mailing Address - Phone:787-981-9855
Mailing Address - Fax:
Practice Address - Street 1:4021 CALLE EL ANAEZ
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-2033
Practice Address - Country:US
Practice Address - Phone:787-981-9855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-26
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR35776-R390200000X
PR23835207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program