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General NPI Number Information
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NPI Number | 1710902242
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Entity Type | Individual
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Provider Name | GLORIA MATTSON HUERTA DNP, FNP-C, AGNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 05/11/2022
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Provider Practice Location Address
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Address Line | 760 WASHBURN AVE STE 5
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City | CORONA
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State | CA
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Zip | 92882-3303
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Country | US
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Telephone | 951-737-0910
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Fax | 951-371-1906
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Provider Business Mailing Address
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Address Line | 4326 COUNTRYDALE RD
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City | RIVERSIDE
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State | CA
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Zip | 92505-3469
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Country | US
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Telephone | 951-343-3309
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 266436
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 12222
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License Number State | CA
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