Provider Demographics
NPI:1447336326
Name:HUERTAS-SOLA, LISETTE (MD)
Entity type:Individual
Prefix:DR
First Name:LISETTE
Middle Name:
Last Name:HUERTAS-SOLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1353 AVE LUIS VIGOREAUX PMB 553
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-2715
Mailing Address - Country:US
Mailing Address - Phone:787-789-2598
Mailing Address - Fax:
Practice Address - Street 1:4ES9 VIA LETICIA
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983-4807
Practice Address - Country:US
Practice Address - Phone:787-769-2410
Practice Address - Fax:787-757-0775
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11949207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG40271Medicare UPIN
PR87720Medicare ID - Type Unspecified