Provider Demographics
NPI:1790976108
Name:HUERTA, BLANCA (PAC)
Entity Type:Individual
Prefix:
First Name:BLANCA
Middle Name:
Last Name:HUERTA
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6195 E 47TH ST
Mailing Address - Street 2:#1
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-6352
Mailing Address - Country:US
Mailing Address - Phone:520-870-2436
Mailing Address - Fax:928-726-6306
Practice Address - Street 1:606 N COUNTRY CLUB
Practice Address - Street 2:#1
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201
Practice Address - Country:US
Practice Address - Phone:480-733-4432
Practice Address - Fax:480-969-0976
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3626207Q00000X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine