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NPI Code Detail

MEDICARE: MISS JAQUELINE HUERTA

MEDICARE: MISS JAQUELINE 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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1093066276
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS JAQUELINE HUERTA
Provider Business Mailing Address
First Line : 1918 ECHO PARK AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90026-1836
Country : US
Telephone Number : 323-605-6186
Fax Number :
Provider Business Practice Location Address
First Line : 1665 W ADAMS BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90007-1533
Country : US
Telephone Number : 323-731-3534
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2012
Last Update Date : 09/27/2012

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Directions to “ MISS JAQUELINE HUERTA ” Practice Location

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