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General NPI Number Information
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NPI Number | 1285490417
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Entity Type | Individual
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Provider Name | ROGER T HUDDLESTONE MD
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Gender | Male
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Dates
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Enumeration Date | 02/26/2024
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Last Update Date | 02/26/2024
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Provider Practice Location Address
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Address Line | 2287 RANCHO PARADISO
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City | ARNOLD
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State | CA
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Zip | 95223
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Country | US
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Telephone | 602-800-6775
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 848
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City | ARNOLD
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State | CA
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Zip | 95223-0848
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Country | US
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Telephone | 510-914-3202
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225CA2400X
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Taxonomy Name | Assistive Technology Practitioner Rehabilitation Counselor
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License Number | N4582943
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License Number State | CA
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