Provider Demographics
NPI:1649233008
Name:HUERTA, SERGIO A (DO)
Entity type:Individual
Prefix:
First Name:SERGIO
Middle Name:A
Last Name:HUERTA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2801 E MISSOURI
Mailing Address - Street 2:SUITE 37
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011
Mailing Address - Country:US
Mailing Address - Phone:575-521-9485
Mailing Address - Fax:575-522-1470
Practice Address - Street 1:1135 S MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2946
Practice Address - Country:US
Practice Address - Phone:575-525-4000
Practice Address - Fax:575-525-4040
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2020-09-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMA-732-81207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM42796Medicaid
NMNM011473OtherBCBS & HMO OF NM
NMP00095766OtherRR MEDICARE
NM201004552OtherPRESBYTERIAN SALUD
NM10003327OtherLOVELACE SALUD
NM201004552OtherPRESBYTERIAN SALUD
NM10003327OtherLOVELACE SALUD