Healthcare Provider Details

I. General information

NPI: 1427849421
Provider Name (Legal Business Name): CARLOS HERRERA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2025
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1359 N GRAND AVE
COVINA CA
91724-1016
US

IV. Provider business mailing address

1359 N GRAND AVE
COVINA CA
91724-1016
US

V. Phone/Fax

Practice location:
  • Phone: 213-954-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-UNOPGI
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: