Healthcare Provider Details

I. General information

NPI: 1588523674
Provider Name (Legal Business Name): MARTIN DE LA HUERTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29532 HYPERION ST
MURRIETA CA
92563-2775
US

IV. Provider business mailing address

29532 HYPERION ST
MURRIETA CA
92563-2775
US

V. Phone/Fax

Practice location:
  • Phone: 619-925-2133
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number4151
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: