Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | F5775801 | CA |
NPI | 1043844459 |
---|---|
Provider Name | Nickolas Sloan Huston |
First Address | Barstow, CA 92311-3614 |
Second Address | Barstow, CA 92311-3614 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2020 |
Last Update Date | 24/02/2020 |