Healthcare Provider Details

I. General information

NPI: 1215363189
Provider Name (Legal Business Name): KIMBERLY ANN HUERTA PSYD.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2013
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25160 EVERETT DR
NEWHALL CA
91321-2416
US

IV. Provider business mailing address

25160 EVERETT DR
NEWHALL CA
91321-2416
US

V. Phone/Fax

Practice location:
  • Phone: 202-486-2463
  • Fax:
Mailing address:
  • Phone: 202-486-2463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number35034
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: