Provider Demographics
NPI:1902561574
Name:HUERTA, DEANNA DENISE (IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:DENISE
Last Name:HUERTA
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4734 CEDARBROOK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-3011
Mailing Address - Country:US
Mailing Address - Phone:361-229-2740
Mailing Address - Fax:
Practice Address - Street 1:4734 CEDARBROOK
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-3011
Practice Address - Country:US
Practice Address - Phone:361-229-2740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-29065174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty