Provider Information for 1396863619
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SANDRA GUADALUPE HUERTA IMF
Sex: Female
NPI: 1396863619
Last Updated: 2007-07-08
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1396863619 | ||||||||
| Enumeration Date | 2007-03-26 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 3544 30TH ST SAN DIEGO, CA 92104-4120 United States Phone: 619-515-2382 | Fax: | ||||||||
| Primary Practice Address | 823 GATEWAY CENTER WAY SAN DIEGO, CA 92102-4541 United States Phone: 619-515-2382 | Fax: | ||||||||
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