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General NPI Number Information
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NPI Number | 1790976108
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Entity Type | Individual
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Provider Name | BLANCA HUERTA PAC
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Gender | Female
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Dates
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Enumeration Date | 08/09/2007
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Last Update Date | 03/09/2020
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Provider Practice Location Address
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Address Line | 606 N COUNTRY CLUB #1
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City | MESA
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State | AZ
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Zip | 85201
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Country | US
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Telephone | 480-733-4432
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Fax | 480-969-0976
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Provider Business Mailing Address
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Address Line | 6195 E 47TH ST #1
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City | YUMA
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State | AZ
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Zip | 85365-6352
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Country | US
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Telephone | 520-870-2436
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Fax | 928-726-6306
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 3626
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number | 3626
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License Number State | AZ
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