Provider Demographics
NPI:1093822520
Name:HUERTA MEDICAL LLC
Entity Type:Organization
Organization Name:HUERTA MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUERTA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:575-649-9225
Mailing Address - Street 1:PO BOX 13638
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88013-3638
Mailing Address - Country:US
Mailing Address - Phone:575-649-9225
Mailing Address - Fax:
Practice Address - Street 1:2801 E. MISSOURI AVE
Practice Address - Street 2:STE 37
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-9151
Practice Address - Country:US
Practice Address - Phone:575-521-9485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM011473OtherBCBS OF NM
NM42796Medicaid
DB2660OtherRR MEDICARE
DB2660OtherRR MEDICARE