Healthcare Provider Details

I. General information

NPI: 1215868526
Provider Name (Legal Business Name): ERICA AZENETTE HUERTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 UNIVERSITY BLVD
LAREDO TX
78041-1920
US

IV. Provider business mailing address

126 ALICANTE DR
LAREDO TX
78046-7458
US

V. Phone/Fax

Practice location:
  • Phone: 956-319-0564
  • Fax:
Mailing address:
  • Phone: 956-319-0564
  • Fax: 956-319-0564

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 StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: