Provider Demographics
NPI:1356868715
Name:HUERTA, MARINA SIMONA
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:SIMONA
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 1:396 OXFORD AVE
Mailing Address - Street 2:
Mailing Address - City:LINDSAY
Mailing Address - State:CA
Mailing Address - Zip Code:93247-2234
Mailing Address - Country:US
Mailing Address - Phone:559-586-3299
Mailing Address - Fax:
Practice Address - Street 1:1425 E WALNUT AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93292-1415
Practice Address - Country:US
Practice Address - Phone:559-625-4072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-26
Last Update Date:2017-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)