Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003461195 |
---|---|
Provider Name | Kevin Huerta Velazquez |
First Address | Fullerton, CA 92832-2029 |
Second Address | Orange, CA 92865-3505 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2019 |
Last Update Date | 23/06/2021 |