Healthcare Provider Details

I. General information

NPI: 1184200909
Provider Name (Legal Business Name): AMBER NICOLE HERRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23950 PRADO LN
COLTON CA
92324-9734
US

IV. Provider business mailing address

23950 PRADO LN
COLTON CA
92324-9734
US

V. Phone/Fax

Practice location:
  • Phone: 909-514-1958
  • Fax:
Mailing address:
  • Phone: 909-514-1958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: