Provider Demographics
NPI:1114309861
Name:HUERTAS, MARTA
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:
Last Name:HUERTAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5721 W SLAUSON AVE
Mailing Address - Street 2:200
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6554
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5721 W SLAUSON AVE
Practice Address - Street 2:200
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6554
Practice Address - Country:US
Practice Address - Phone:310-695-7866
Practice Address - Fax:310-846-4112
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management