Provider Demographics
NPI:1598187080
Name:HUERTA, NATALIA MICHELLE (MS)
Entity type:Individual
Prefix:
First Name:NATALIA
Middle Name:MICHELLE
Last Name:HUERTA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24910 WASHINGTON AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-9284
Mailing Address - Country:US
Mailing Address - Phone:951-595-7488
Mailing Address - Fax:
Practice Address - Street 1:24910 WASHINGTON AVE STE 301
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-9284
Practice Address - Country:US
Practice Address - Phone:951-595-7488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-17
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA113137106H00000X
CA94281106H00000X, 106H00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program