Provider Demographics
NPI:1164759643
Name:FELIX HUERTA MD A PROFESSIONAL
Entity Type:Organization
Organization Name:FELIX HUERTA MD A PROFESSIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:F
Authorized Official - Last Name:HUERTA-IBARRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-722-2010
Mailing Address - Street 1:50 PENNY LN
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-3079
Mailing Address - Country:US
Mailing Address - Phone:831-722-2010
Mailing Address - Fax:831-722-2037
Practice Address - Street 1:50 PENNY LN
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-3079
Practice Address - Country:US
Practice Address - Phone:831-722-2010
Practice Address - Fax:831-722-2037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A941152207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACQ255AOtherPTAN
CACQ255AOtherPTAN
CA00A94115Medicare PIN