Provider Demographics
NPI:1700144508
Name:MACALALAD-HUERTA, MARYTERRIE ROSE (MD)
Entity Type:Individual
Prefix:MS
First Name:MARYTERRIE
Middle Name:ROSE
Last Name:MACALALAD-HUERTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:MARY TERRIE ROSE
Other - Middle Name:DAYAO
Other - Last Name:MACALALAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:27107 TOURNEY RD
Mailing Address - Street 2:DEPARTMENT OF FAMILY MEDICINE
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1860
Mailing Address - Country:US
Mailing Address - Phone:661-222-2420
Mailing Address - Fax:
Practice Address - Street 1:27107 TOURNEY RD
Practice Address - Street 2:DEPARTMENT OF FAMILY MEDICINE
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91355-1860
Practice Address - Country:US
Practice Address - Phone:661-222-2420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA130536207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine