Healthcare Provider Details

I. General information

NPI: 1568277200
Provider Name (Legal Business Name): ALAN HUIZAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 KPC PKWY
CORONA CA
92879-7102
US

IV. Provider business mailing address

7691 BROADMOOR PL
RANCHO CUCAMONGA CA
91730-6830
US

V. Phone/Fax

Practice location:
  • Phone: 951-509-5000
  • Fax:
Mailing address:
  • Phone: 909-240-7128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: