Provider Demographics
NPI:1760149488
Name:AMEZCUA-HUERTA, MARIA SOLEDAD (APRN)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:SOLEDAD
Last Name:AMEZCUA-HUERTA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 370520
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89137-0520
Mailing Address - Country:US
Mailing Address - Phone:702-909-0028
Mailing Address - Fax:
Practice Address - Street 1:4680 POLARIS AVE STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-5600
Practice Address - Country:US
Practice Address - Phone:702-909-0028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV838193363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner