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NPI Code Detail

MEDICARE: EVA HUERTA

MEDICARE: EVA HUERTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care CoordinatorCA
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1073038360
Entity Type Code : Individual
Provider Name (Legal Business Name) : EVA HUERTA
Provider Business Mailing Address
First Line : 1950 S SUNWEST LN STE 200
Second Line :
City : SAN BERNARDINO
State : CA
Zip : 92408-3248
Country : US
Telephone Number : 909-252-4017
Fax Number :
Provider Business Practice Location Address
First Line : 1950 S SUNWEST LN STE 200
Second Line :
City : SAN BERNARDINO
State : CA
Zip : 92408-3248
Country : US
Telephone Number : 909-252-4017
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2017
Last Update Date : 07/21/2022

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Directions to “ EVA HUERTA ” Practice Location

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