=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417766494
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MYRNA LINNETTE HUERTAS MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2025
-----------------------------------------------------
Last Update Date | 01/27/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CAROLINA SHOPPING COURT, AV. 65 DE INFANTERIA 10000 SUITE 201-A
-----------------------------------------------------
City | CAROLINA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00985
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-200-7833
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | COMUNIDAD LAS QUINIENTAS #125
-----------------------------------------------------
City | ARROYO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-929-2519
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | 24779
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------