1508841982 NPI number — DR. BEATRIZ HUERTAS RIVERA M.D.

Table of content: (NPI 1285806034)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508841982 NPI number — DR. BEATRIZ HUERTAS RIVERA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUERTAS RIVERA
Provider First Name:
BEATRIZ
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508841982
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 746715
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30374-6715
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-352-1515
Provider Business Mailing Address Fax Number:
312-929-0373

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1819 N HARLEM AVE STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60707-3716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-589-4385
Provider Business Practice Location Address Fax Number:
872-228-8601
Provider Enumeration Date:
12/08/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  036113545 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 036113545 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01636473 . This is a "BCBS ILLINOIS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".