Healthcare Provider Details

I. General information

NPI: 1033122296
Provider Name (Legal Business Name): JAMES M HUOT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4343 YAQUI PASS RD
BORREGO SPRINGS CA
92004-2369
US

IV. Provider business mailing address

PO BOX 7849
RIVERSIDE CA
92513-7849
US

V. Phone/Fax

Practice location:
  • Phone: 760-767-5051
  • Fax: 760-767-4552
Mailing address:
  • Phone: 951-358-5222
  • Fax: 951-358-5235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG83499
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: