Provider Information for 1881199693
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RAQUEL ILANIT HUERTA
Sex: Female
NPI: 1881199693
Last Updated: 2018-03-26
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1881199693 | ||||||||
| Enumeration Date | 2018-03-26 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 2100 HAVEN RD APT C WILMINGTON, DE 19809 United States Phone: 313-482-8683 | Fax: | ||||||||
| Primary Practice Address | 2100 HAVEN RD APT C WILMINGTON, DE 19809 United States Phone: 313-482-8683 | Fax: | ||||||||
| Secondary Practice Address(es) | 314 E MAIN ST STE 402 | ||||||||
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