Provider Demographics
NPI:1073275210
Name:HUERTA, ANNETTE NICOLE
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:NICOLE
Last Name:HUERTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12659 WESTWAY
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-0511
Mailing Address - Country:US
Mailing Address - Phone:626-675-5506
Mailing Address - Fax:
Practice Address - Street 1:268 MCARTHUR WAY
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-5615
Practice Address - Country:US
Practice Address - Phone:909-406-5353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker