Provider Demographics
NPI:1790791614
Name:HUERTA-IBARRA, JOSE FELIX (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:FELIX
Last Name:HUERTA-IBARRA
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 1:50 PENNY LANE
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-0007
Mailing Address - Country:US
Mailing Address - Phone:831-722-2010
Mailing Address - Fax:831-722-2037
Practice Address - Street 1:50 PENNY LANE
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-0007
Practice Address - Country:US
Practice Address - Phone:831-722-2010
Practice Address - Fax:831-722-2037
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94115207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA94115Medicare UPIN
CAA94115Medicare UPIN
CAHSP40248FMedicare ID - Type UnspecifiedCOUNTY OF MONTEREY NMC
CAZZZ93236ZMedicare ID - Type UnspecifiedCOUNTY OF MONTEREY NMC