Basic Information
| Provider Information | |||||||||
| NPI: | 1962606541 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MONTIEL HURTADO | ||||||||
| FirstName: | CARLOS | ||||||||
| MiddleName: | ENRIQUE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 709 W ORCHARD DR STE 4 | ||||||||
| Address2: | |||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982251766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603188800 | ||||||||
| FaxNumber: | 3603181085 | ||||||||
| Practice Location | |||||||||
| Address1: | 2075 BARKLEY BLVD | ||||||||
| Address2: | #105 | ||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982266614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606713345 | ||||||||
| FaxNumber: | 3606501354 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2007 | ||||||||
| LastUpdateDate: | 07/13/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD60002202 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2795270824 | 01 | MYUTMB 2795270824-COMMERCIAL NUMBER | OTHER | 0275784 | 01 | WA | L&I | OTHER | 8685901 | 01 | WA | WA DSHS | OTHER | 238292 | 01 | WA | L & I | OTHER |