Provider Demographics
NPI:1659167229
Name:HUERTA, PRISCILLA GUADALUPE I
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:GUADALUPE
Last Name:HUERTA
Suffix:I
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 W CHAPMAN AVE STE 122
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2648
Mailing Address - Country:US
Mailing Address - Phone:949-989-6932
Mailing Address - Fax:949-989-7608
Practice Address - Street 1:2050 W CHAPMAN AVE STE 122
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2648
Practice Address - Country:US
Practice Address - Phone:949-989-6932
Practice Address - Fax:949-989-7608
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician