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General NPI Number Information
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NPI Number | 1548532534
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Entity Type | Individual
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Provider Name | ROBERT E HUITT JR. PTA
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Gender | Male
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Dates
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Enumeration Date | 02/06/2012
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 1717 E BIRCH ST APT A205
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City | BREA
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State | CA
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Zip | 92821-5100
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Country | US
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Telephone | 562-458-2095
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Fax |
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Provider Business Mailing Address
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Address Line | 1717 E BIRCH ST APT H205
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City | BREA
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State | CA
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Zip | 92821-5110
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Country | US
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Telephone | 562-685-3399
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | AT206
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License Number State | CA
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