Healthcare Provider Details

I. General information

NPI: 1710408729
Provider Name (Legal Business Name): ALBERTO HUERTA MS, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 ENFILADE AVE
FOOTHILL RANCH CA
92610
US

IV. Provider business mailing address

11 ENFILADE AVE
FOOTHILL RANCH CA
92610-2322
US

V. Phone/Fax

Practice location:
  • Phone: 530-908-4624
  • Fax:
Mailing address:
  • Phone: 530-908-4624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000028976
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: