Provider Demographics
NPI:1386228708
Name:HUERTA, JEREMY ROBERT (BEHAVIOR THERAPIST)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:ROBERT
Last Name:HUERTA
Suffix:
Gender:M
Credentials:BEHAVIOR THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 WATT AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-5027
Mailing Address - Country:US
Mailing Address - Phone:916-448-2050
Mailing Address - Fax:916-448-6050
Practice Address - Street 1:591 WATT AVE STE 120
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-5027
Practice Address - Country:US
Practice Address - Phone:916-448-2050
Practice Address - Fax:916-448-6050
Is Sole Proprietor?:No
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician