Provider Demographics
NPI:1215780556
Name:HUFF, IDELLA
Entity type:Individual
Prefix:
First Name:IDELLA
Middle Name:
Last Name:HUFF
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 1:1031 SUTHERLAND DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-1465
Mailing Address - Country:US
Mailing Address - Phone:209-420-3547
Mailing Address - Fax:
Practice Address - Street 1:1031 SUTHERLAND DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-1465
Practice Address - Country:US
Practice Address - Phone:209-420-3547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide