Provider Demographics
NPI:1609699875
Name:HUERTA, ISABELLA JADE
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:JADE
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 1:3120 W MARCH LN STE 2D
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-8235
Mailing Address - Country:US
Mailing Address - Phone:209-425-4041
Mailing Address - Fax:
Practice Address - Street 1:3120 W MARCH LN STE 2D
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-8235
Practice Address - Country:US
Practice Address - Phone:209-425-4041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician