Healthcare Provider Details

I. General information

NPI: 1184530255
Provider Name (Legal Business Name): CRYSTAL HUERTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 CENTER ST NE
SALEM OR
97301-2682
US

IV. Provider business mailing address

7898 JANI CT NE
KEIZER OR
97303-1680
US

V. Phone/Fax

Practice location:
  • Phone: 503-945-9964
  • Fax:
Mailing address:
  • Phone: 971-599-8388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number201809900RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201809900RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: