Healthcare Provider Details

I. General information

NPI: 1194413302
Provider Name (Legal Business Name): GENESIS SOFIA HUERTA VERA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 THOMPSON LN STE 37189
NASHVILLE TN
37204-4716
US

IV. Provider business mailing address

1161 21ST AVE S
NASHVILLE TN
37232-0011
US

V. Phone/Fax

Practice location:
  • Phone: 615-875-5111
  • Fax:
Mailing address:
  • Phone: 615-343-4578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: