MEDICARE: SERGIO A. HUERTA DO

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	207Q00000X	Family Medicine Physician	A-732-81	NM

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00095766	OTHER	NM	RR MEDICARE

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	NM011473	OTHER	NM	BCBS & HMO OF NM
4	201004552	OTHER	NM	PRESBYTERIAN SALUD
5	10003327	OTHER	NM	LOVELACE SALUD

General Provider Information

NPI Number	:	1649233008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SERGIO A. HUERTA DO

Provider Business Mailing Address
First Line	:	2801 E MISSOURI
Second Line	:	SUITE 37
City	:	LAS CRUCES
State	:	NM
Zip	:	88011
Country	:	US
Telephone Number	:	575-521-9485
Fax Number	:	575-522-1470

Provider Business Practice Location Address
First Line	:	1135 S MAIN ST STE B
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-2946
Country	:	US
Telephone Number	:	575-525-4000
Fax Number	:	575-525-4040

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	09/14/2020

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Directions to “ SERGIO A. HUERTA DO” Practice Location

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