Healthcare Provider Details

I. General information

NPI: 1033810270
Provider Name (Legal Business Name): CHRISTOPHER MARK HUERTA ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CHRIS MARK HUERTA

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 KING ST
SAN GABRIEL CA
91776-2320
US

IV. Provider business mailing address

815 KING ST
SAN GABRIEL CA
91776-2320
US

V. Phone/Fax

Practice location:
  • Phone: 626-429-8057
  • Fax:
Mailing address:
  • Phone: 626-429-8057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: