Healthcare Provider Details

I. General information

NPI: 1215780556
Provider Name (Legal Business Name): IDELLA HUFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 04/08/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 SUTHERLAND DR
STOCKTON CA
95210-1465
US

IV. Provider business mailing address

1031 SUTHERLAND DR
STOCKTON CA
95210-1465
US

V. Phone/Fax

Practice location:
  • Phone: 209-420-3547
  • Fax:
Mailing address:
  • Phone: 209-420-3547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: