Provider Demographics
NPI:1669262986
Name:HUIZAR, ASH GISELLE-CECILIA
Entity type:Individual
Prefix:
First Name:ASH
Middle Name:GISELLE-CECILIA
Last Name:HUIZAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GISELLE
Other - Middle Name:CECILIA
Other - Last Name:HUIZAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1027 BALSAM ST
Mailing Address - Street 2:
Mailing Address - City:CALIMESA
Mailing Address - State:CA
Mailing Address - Zip Code:92320-4912
Mailing Address - Country:US
Mailing Address - Phone:951-616-0199
Mailing Address - Fax:
Practice Address - Street 1:473 EAST CARNEGIE DR
Practice Address - Street 2:200
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-4201
Practice Address - Country:US
Practice Address - Phone:909-277-6090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-09
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician