Provider Demographics
NPI:1477538452
Name:HUERTA, KRISTA (MD)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
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 1:788 HARRISON ST APT 527
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-4211
Mailing Address - Country:US
Mailing Address - Phone:415-994-3763
Mailing Address - Fax:
Practice Address - Street 1:901 NEVIN AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94801-3143
Practice Address - Country:US
Practice Address - Phone:510-307-1722
Practice Address - Fax:510-307-1725
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75515207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A755150Medicaid
CA00A755150Medicare ID - Type Unspecified
CA00A755150Medicaid