=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063423002
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. FIDEL BERNARD HUERTA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1111 COLUMBUS ST
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-326-5052
-----------------------------------------------------
Fax | 661-862-7635
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 6578
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93386
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-326-5052
-----------------------------------------------------
Fax | 661-862-7365
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | G66490
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------