Provider Demographics
NPI:1740045582
Name:HUERTA, RACHAEL ARLENE
Entity type:Individual
Prefix:MS
First Name:RACHAEL
Middle Name:ARLENE
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 1:308 E SAN JACINTO AVE
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92570-2878
Mailing Address - Country:US
Mailing Address - Phone:951-439-1689
Mailing Address - Fax:951-704-7864
Practice Address - Street 1:308 E SAN JACINTO AVE
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92570-2878
Practice Address - Country:US
Practice Address - Phone:951-439-1689
Practice Address - Fax:951-704-7864
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-20
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172V00000X, 175T00000X
CAMPSS-DLIMJT175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No172V00000XOther Service ProvidersCommunity Health Worker