Provider Demographics
NPI:1245920222
Name:HUERTA, VERENNA
Entity type:Individual
Prefix:
First Name:VERENNA
Middle Name:
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:PO BOX 5715
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-0715
Mailing Address - Country:US
Mailing Address - Phone:760-983-3578
Mailing Address - Fax:
Practice Address - Street 1:3636 CAMINO DEL RIO N STE 150
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1709
Practice Address - Country:US
Practice Address - Phone:858-956-0179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator