MEDICARE: FIDEL G HUERTA JR. INC.

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
1	332B00000X	Durable Medical Equipment & Medical Supplies	14577	TX

General Provider Information

NPI Number	:	1285843490
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIDEL G HUERTA JR. INC.

Provider Business Mailing Address
First Line	:	4006 NOGALITOS
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78211-1300
Country	:	US
Telephone Number	:	210-924-5163
Fax Number	:	210-924-3122

Provider Business Practice Location Address
First Line	:	4006 NOGALITOS
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78211-1300
Country	:	US
Telephone Number	:	210-924-5163
Fax Number	:	210-924-3122

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. ANTHONY C HARPEL JR.
Credential	:
Telephone Number	:	210-433-5400

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	08/22/2020

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