Healthcare Provider Details

I. General information

NPI: 1629509906
Provider Name (Legal Business Name): HUERTAS COLLEGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 AVENIDA JOSE VILLARES CARRETERA 189
CAGUAS PR
00725
US

IV. Provider business mailing address

PO BOX 8429
CAGUAS PR
00726-8429
US

V. Phone/Fax

Practice location:
  • Phone: 787-746-1400
  • Fax: 787-743-0203
Mailing address:
  • Phone: 787-746-1400
  • Fax: 787-743-0203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StatePR

VIII. Authorized Official

Name: MS. MARIA DEL MAR LOPEZ
Title or Position: PRESIDENT
Credential:
Phone: 787-746-1400