Provider Demographics
NPI:1184258006
Name:HUERTA, ROMINA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ROMINA
Middle Name:
Last Name:HUERTA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 HARDING AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-1251
Mailing Address - Country:US
Mailing Address - Phone:818-723-9862
Mailing Address - Fax:
Practice Address - Street 1:1301 20TH ST STE 300
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2087
Practice Address - Country:US
Practice Address - Phone:310-829-7792
Practice Address - Fax:310-829-4136
Is Sole Proprietor?:No
Enumeration Date:2020-02-29
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29581235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist