Provider Demographics
NPI:1689072175
Name:HUERTAS-BAUZA, DIANA I
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:I
Last Name:HUERTAS-BAUZA
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:DIANA
Other - Middle Name:I
Other - Last Name:HUERTAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:C17 CALLE MARGINAL
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-6706
Mailing Address - Country:US
Mailing Address - Phone:787-780-1273
Mailing Address - Fax:787-786-8690
Practice Address - Street 1:C17 CALLE MARGINAL
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6706
Practice Address - Country:US
Practice Address - Phone:787-780-1273
Practice Address - Fax:787-786-8690
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-15
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23476208D00000X
PR000618-P.A.363AM0700X
PR16233-I390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical