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General NPI Number Information
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NPI Number | 1619893823
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Entity Type | Individual
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Provider Name | JEREMY HUSTON
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Gender | Male
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Dates
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Enumeration Date | 06/24/2026
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Last Update Date | 06/24/2026
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Provider Practice Location Address
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Address Line | 85 RAMONA EXPY
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City | PERRIS
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State | CA
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Zip | 92571-7014
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Country | US
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Telephone | 951-349-4195
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Fax | 951-490-0123
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Provider Business Mailing Address
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Address Line | 12875 RANCH RD
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City | COLTON
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State | CA
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Zip | 92324-9726
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Country | US
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Telephone | 702-516-8707
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State | CA
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