Provider Demographics
NPI:1467276188
Name:HUFFORD, JOSEPH DEAN
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:DEAN
Last Name:HUFFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 PRINCETON DR
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-6165
Mailing Address - Country:US
Mailing Address - Phone:949-302-3312
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 104
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:CA
Practice Address - Zip Code:95439-0104
Practice Address - Country:US
Practice Address - Phone:949-302-3312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-09
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician