Provider Demographics
NPI:1316000912
Name:FIDEL G HUERTA JR. INC
Entity type:Organization
Organization Name:FIDEL G HUERTA JR. INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FIDEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:HUERTA
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:210-433-9991
Mailing Address - Street 1:818 BROOKLYN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78215-1607
Mailing Address - Country:US
Mailing Address - Phone:210-433-5400
Mailing Address - Fax:210-433-5450
Practice Address - Street 1:818 BROOKLYN AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1607
Practice Address - Country:US
Practice Address - Phone:210-433-5400
Practice Address - Fax:210-433-5450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23802333600000X
TX17446332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX014394301Medicaid
TX068330201Medicaid
TX068330201Medicaid