Provider Demographics
NPI:1154315646
Name:HUETTE, JOHN ALLEN (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALLEN
Last Name:HUETTE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:16702 VALLEY VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-5824
Mailing Address - Country:US
Mailing Address - Phone:714-367-5360
Mailing Address - Fax:714-635-5428
Practice Address - Street 1:27455 TIERRA ALTA WAY STE A
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-3498
Practice Address - Country:US
Practice Address - Phone:951-699-5282
Practice Address - Fax:951-694-8652
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A3933208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020A39330Medicare ID - Type Unspecified
CAE10455Medicare UPIN