Provider Demographics
NPI:1407638653
Name:HUERTAS DONES, CARLOS MARIO (PA)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:MARIO
Last Name:HUERTAS DONES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:L-15 CALLE JUAN RAMOS
Mailing Address - Street 2:URBA SANTA PAULA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5903
Mailing Address - Country:US
Mailing Address - Phone:939-630-4566
Mailing Address - Fax:
Practice Address - Street 1:L-15 CALLE JUAN RAMOS
Practice Address - Street 2:URBA SANTA PAULA
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-5903
Practice Address - Country:US
Practice Address - Phone:939-630-4566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR01461-P.A.363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical