Healthcare Provider Details

I. General information

NPI: 1841601507
Provider Name (Legal Business Name): JAEL HUIZAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2014
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 CALIFORNIA AVE
CORONA CA
92881-6470
US

IV. Provider business mailing address

13506 PALOMINO CREEK DR
CORONA CA
92883-6282
US

V. Phone/Fax

Practice location:
  • Phone: 951-258-8907
  • Fax:
Mailing address:
  • Phone: 951-258-8907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number121894
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number102118
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: