Healthcare Provider Details

I. General information

NPI: 1225708704
Provider Name (Legal Business Name): ROSA HUERTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1236 NW 99TH ST
OKLAHOMA CITY OK
73114-4906
US

IV. Provider business mailing address

4900 RICHMOND SQ
OKLAHOMA CITY OK
73118-2028
US

V. Phone/Fax

Practice location:
  • Phone: 405-361-4911
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: