Provider Demographics
NPI:1437888245
Name:HUERTA, NATHALIA YORIKO
Entity Type:Individual
Prefix:
First Name:NATHALIA
Middle Name:YORIKO
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 1:23281 GUINEA ST
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-3830
Mailing Address - Country:US
Mailing Address - Phone:949-302-2484
Mailing Address - Fax:
Practice Address - Street 1:1845 W ORANGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2051
Practice Address - Country:US
Practice Address - Phone:949-630-8290
Practice Address - Fax:949-396-1242
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician