Provider Demographics
NPI:1861118572
Name:HUICOCHEA, JESSE DONATO
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:DONATO
Last Name:HUICOCHEA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11979 WELBY PL
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-6436
Mailing Address - Country:US
Mailing Address - Phone:909-450-4092
Mailing Address - Fax:
Practice Address - Street 1:11979 WELBY PL
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-6436
Practice Address - Country:US
Practice Address - Phone:909-450-4092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist