MEDICARE: JOSE HUITRON RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	718041	CA

General Provider Information

NPI Number	:	1306276555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE HUITRON RN

Provider Business Mailing Address
First Line	:	3354 WOODHAVEN LN
Second Line	:
City	:	CONCORD
State	:	CA
Zip	:	94519-2020
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3354 WOODHAVEN LN
Second Line	:
City	:	CONCORD
State	:	CA
Zip	:	94519-2020
Country	:	US
Telephone Number	:	925-521-4979
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/24/2013
Last Update Date	:	11/24/2013

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