Healthcare Provider Details

I. General information

NPI: 1669627139
Provider Name (Legal Business Name): MR. ERIK MICHAEL HERRERA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2008
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1756 S LEWIS RD
CAMARILLO CA
93012-8520
US

IV. Provider business mailing address

2426 KIRCH FLAT AVE
TULARE CA
93274-4264
US

V. Phone/Fax

Practice location:
  • Phone: 805-383-3669
  • Fax: 805-987-5422
Mailing address:
  • Phone: 805-701-6872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number62899
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: