Provider Demographics
NPI:1366452781
Name:HUOTT, PATRICK A (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:A
Last Name:HUOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6010 HIDDEN VALLEY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-4219
Mailing Address - Country:US
Mailing Address - Phone:760-631-3000
Mailing Address - Fax:760-631-3016
Practice Address - Street 1:31515 RANCHO PUEBLO RD STE 104
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-4837
Practice Address - Country:US
Practice Address - Phone:760-631-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG726462084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G726460Medicaid
CAF79927Medicare UPIN
CA00G726460Medicaid