Healthcare Provider Details

I. General information

NPI: 1508473034
Provider Name (Legal Business Name): ST HUERTA FOUR SQUARE CLINICALS PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N ARLINGTON AVE STE 340A
RENO NV
89501-1248
US

IV. Provider business mailing address

650 N ROSE DR STE 472
PLACENTIA CA
92870-7513
US

V. Phone/Fax

Practice location:
  • Phone: 775-238-3082
  • Fax: 844-872-5607
Mailing address:
  • Phone: 714-345-6944
  • Fax: 844-872-5607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVEN THOMAS HUERTA
Title or Position: DIRECTOR
Credential: DNP
Phone: 775-238-3082