Provider Demographics
NPI:1780679860
Name:HUERTAS, ENRIQUE J (MD)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:J
Last Name:HUERTAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3503
Mailing Address - Country:US
Mailing Address - Phone:305-649-4117
Mailing Address - Fax:305-649-4207
Practice Address - Street 1:1831 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3503
Practice Address - Country:US
Practice Address - Phone:305-649-4117
Practice Address - Fax:305-649-4207
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2010-01-21
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
FL0044902207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL049756800Medicaid
FL04861Medicare PIN
FLD84820Medicare UPIN