Provider Demographics
NPI:1336108166
Name:HUERTA, GREDIA M (MD)
Entity Type:Individual
Prefix:DR
First Name:GREDIA
Middle Name:M
Last Name:HUERTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3916
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-3916
Mailing Address - Country:US
Mailing Address - Phone:787-999-0753
Mailing Address - Fax:787-999-0719
Practice Address - Street 1:1451 ASHFORD
Practice Address - Street 2:CONDADO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1511
Practice Address - Country:US
Practice Address - Phone:787-722-6004
Practice Address - Fax:787-722-6003
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14090207PP0204X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics