Provider Demographics
NPI:1689456576
Name:HUERTA, JESUS
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:
Last Name:HUERTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 NUGGET ST
Mailing Address - Street 2:
Mailing Address - City:PENITAS
Mailing Address - State:TX
Mailing Address - Zip Code:78576-8207
Mailing Address - Country:US
Mailing Address - Phone:956-252-0784
Mailing Address - Fax:
Practice Address - Street 1:1706 NUGGET ST
Practice Address - Street 2:
Practice Address - City:PENITAS
Practice Address - State:TX
Practice Address - Zip Code:78576-8207
Practice Address - Country:US
Practice Address - Phone:956-252-0784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide