Provider Demographics
NPI:1588269120
Name:HUERTA, JAIME CARLOS
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:CARLOS
Last Name:HUERTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2003 AMACHE CIR
Mailing Address - Street 2:
Mailing Address - City:GRANADA
Mailing Address - State:CO
Mailing Address - Zip Code:81041-5004
Mailing Address - Country:US
Mailing Address - Phone:719-688-1637
Mailing Address - Fax:
Practice Address - Street 1:2003 AMACHE CIR
Practice Address - Street 2:
Practice Address - City:GRANADA
Practice Address - State:CO
Practice Address - Zip Code:81041-5004
Practice Address - Country:US
Practice Address - Phone:719-688-1637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer