| Doctor Name: | RYAN HUERTO |
| NPI Number: | 1023472818 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 1001 Potrero Ave Bldg 80-83 San Francisco, CA - 941103518 |
| Business Phone Number: | 4152065252 |
| Business Fax Number: | |
| Mailing Address: | 2640 E. 218th St., CARSON |
| State: | CA |
| Postal Code: | 908100745 |
| Phone Number: | 3107146985 |
| Fax Number: | |
| NPI Enumeration Date: | 04/08/2016 |
| NPI Last Update Date: | 04/08/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |