Provider Demographics
NPI:1114003605
Name:A & I HUATUCO, INC.
Entity Type:Organization
Organization Name:A & I HUATUCO, INC.
Other - Org Name:AIBAR HUATUCO, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AIBAR
Authorized Official - Middle Name:HERBERTO
Authorized Official - Last Name:HUATUCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-836-1627
Mailing Address - Street 1:1530 BESSIE AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-3080
Mailing Address - Country:US
Mailing Address - Phone:209-836-1627
Mailing Address - Fax:209-836-5478
Practice Address - Street 1:1530 BESSIE AVE STE 102
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3080
Practice Address - Country:US
Practice Address - Phone:209-836-1627
Practice Address - Fax:209-836-5478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ29934ZMedicare ID - Type UnspecifiedGROUP ID