=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407705742
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GRISELDA HUERTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2026
-----------------------------------------------------
Last Update Date | 01/28/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1586 W SHAW AVE # 93711
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93711-3502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-512-3526
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 175 DWYER ST APT 21
-----------------------------------------------------
City | MADERA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93637-5143
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-512-3526
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------