Basic Information
| Provider Information | |||||||||
| NPI: | 1396863619 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUERTA | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | GUADALUPE | ||||||||
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| Credential: | IMF | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3544 30TH ST | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921044120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195152382 | ||||||||
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| Practice Location | |||||||||
| Address1: | 823 GATEWAY CENTER WAY | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921024541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195152382 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 52152 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.