Provider Demographics
NPI:1477758746
Name:DE LA HUERGA, DOLORES ALTAGRACIA (MD)
Entity Type:Individual
Prefix:DR
First Name:DOLORES
Middle Name:ALTAGRACIA
Last Name:DE LA HUERGA
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 1:1458 CALLE AIBONITO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909-2634
Mailing Address - Country:US
Mailing Address - Phone:787-723-4882
Mailing Address - Fax:787-721-3399
Practice Address - Street 1:1458 CALLE AIBONITO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2634
Practice Address - Country:US
Practice Address - Phone:787-723-4882
Practice Address - Fax:787-721-3399
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2646207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2646OtherM.D.