Healthcare Provider Details

I. General information

NPI: 1124956123
Provider Name (Legal Business Name): MYA DESTENY HUERTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 RAMAPO VALLEY RD # 100
OAKLAND NJ
07436-2702
US

IV. Provider business mailing address

77 PASSAIC AVE
HAWTHORNE NJ
07506-1433
US

V. Phone/Fax

Practice location:
  • Phone: 973-830-9248
  • Fax: 845-285-9012
Mailing address:
  • Phone: 862-213-2243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: