Healthcare Provider Details

I. General information

NPI: 1548534597
Provider Name (Legal Business Name): ENRIQUE J HUERTAS JR MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2012
Last Update Date: 03/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1831 NW 7TH ST
MIAMI FL
33125-3503
US

IV. Provider business mailing address

1831 NW 7TH ST
MIAMI FL
33125-3503
US

V. Phone/Fax

Practice location:
  • Phone: 305-649-4117
  • Fax: 305-649-4207
Mailing address:
  • Phone: 305-649-4117
  • Fax: 305-649-4207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME 44902
License Number StateFL

VIII. Authorized Official

Name: ENRIQUE HUERTAS
Title or Position: OWNER
Credential: MD
Phone: 305-649-4117