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
2	3336C0003X	Community/Retail Pharmacy	14577	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4583781	OTHER	TX	NCPDP OR NABP

General Provider Information

NPI Number	:	1558406819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIDEL G. HUERTA JR., INC.

Provider Business Mailing Address
First Line	:	4006 NOGALITOS
Second Line	:	SUITE 1
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	:	SUITE 1
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	:	OWNER PRESIDENT
Name	:	FIDEL G HUERTA JR.
Credential	:	RPH
Telephone Number	:	210-433-9991

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	12/16/2008

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Directions to “FIDEL G. HUERTA JR., INC. ” Practice Location

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