Basic Information
| Provider Information | |||||||||
| NPI: | 1356785448 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUERTA | ||||||||
| FirstName: | IRENE | ||||||||
| MiddleName: | RAQUEL | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | WHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7121 S PADRE ISLAND DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784124939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3619936000 | ||||||||
| FaxNumber: | 3619930266 | ||||||||
| Practice Location | |||||||||
| Address1: | 7121 S PADRE ISLAND DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | CORPUS CHRISTI | ||||||||
| State: | TX | ||||||||
| PostalCode: | 784124939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3619936000 | ||||||||
| FaxNumber: | 3619930266 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2013 | ||||||||
| LastUpdateDate: | 08/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | AP122238 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
ID Information
| ID | Type | State | Issuer | Description | 329976003 | 05 | TX | MEDICAID | AP122238 | 01 | TX | TX BOARD OF NURSING - WOMEN'S HEALTH NURSE PRACTITIONER | OTHER | 104322768 | 01 | NATIONAL CERTIFICATION CORPORATION - WHNP-BC | OTHER |