Healthcare Provider Details

I. General information

NPI: 1962858514
Provider Name (Legal Business Name): JAMES HUFFSTETER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2016
Last Update Date: 05/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3312 PURVIS AVE
CLOVIS CA
93619-5112
US

IV. Provider business mailing address

3312 PURVIS AVE
CLOVIS CA
93619-5112
US

V. Phone/Fax

Practice location:
  • Phone: 559-349-3135
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number768669
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: