Healthcare Provider Details

I. General information

NPI: 1801298955
Provider Name (Legal Business Name): HEATHER SPENCER HUARTE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2014
Last Update Date: 09/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18251 SHARON LN
VILLA PARK CA
92861-4529
US

IV. Provider business mailing address

18251 SHARON LN
VILLA PARK CA
92861-4529
US

V. Phone/Fax

Practice location:
  • Phone: 714-532-9818
  • Fax:
Mailing address:
  • Phone: 714-532-9818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG85515
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number24292
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: