Healthcare Provider Details

I. General information

NPI: 1407856446
Provider Name (Legal Business Name): JOSE HUERTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 AVE. ARTERIAL HOSTOS CAPITAL CENTER BLDG. SUITE 604
SAN JUAN PR
00918
US

IV. Provider business mailing address

C4 CALLE 2 VILLAS DE SAN FRANCISCO
SAN JUAN PR
00927-6445
US

V. Phone/Fax

Practice location:
  • Phone: 787-754-8333
  • Fax: 787-766-0082
Mailing address:
  • Phone: 787-751-3337
  • Fax: 787-754-8582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number11287
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: