Provider Demographics
NPI:1548532534
Name:HUITT, ROBERT E JR (PTA)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:E
Last Name:HUITT
Suffix:JR
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 E BIRCH ST APT H205
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-5110
Mailing Address - Country:US
Mailing Address - Phone:562-685-3399
Mailing Address - Fax:
Practice Address - Street 1:1717 E BIRCH ST APT A205
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5100
Practice Address - Country:US
Practice Address - Phone:562-458-2095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT206172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker