Provider Demographics
NPI:1376836627
Name:HUERTA, FILOMENA
Entity Type:Individual
Prefix:
First Name:FILOMENA
Middle Name:
Last Name:HUERTA
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 1:935 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-2349
Mailing Address - Country:US
Mailing Address - Phone:760-482-4438
Mailing Address - Fax:760-352-7747
Practice Address - Street 1:935 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-2349
Practice Address - Country:US
Practice Address - Phone:442-265-1376
Practice Address - Fax:442-265-1467
Is Sole Proprietor?:No
Enumeration Date:2011-05-19
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator