Provider Demographics
NPI:1033810270
Name:HUERTA, CHRISTOPHER MARK (ATC)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:MARK
Last Name:HUERTA
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:MARK
Other - Last Name:HUERTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:815 KING ST
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-2320
Mailing Address - Country:US
Mailing Address - Phone:626-429-8057
Mailing Address - Fax:
Practice Address - Street 1:815 KING ST
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-2320
Practice Address - Country:US
Practice Address - Phone:626-429-8057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer