Healthcare Provider Details

I. General information

NPI: 1326871997
Provider Name (Legal Business Name): MR. DAVID DUANE HUFSTELER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6707 EMBARCADERO DR
STOCKTON CA
95219-3382
US

IV. Provider business mailing address

6707 EMBARCADERO DR
STOCKTON CA
95219-3382
US

V. Phone/Fax

Practice location:
  • Phone: 916-849-3537
  • Fax:
Mailing address:
  • Phone: 916-849-3537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT143088
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: