Healthcare Provider Details

I. General information

NPI: 1215690318
Provider Name (Legal Business Name): WENDY JANETH PALMA HERRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2021
Last Update Date: 06/27/2025
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4760 SEPULVEDA BLVD
CULVER CITY CA
90230-4820
US

IV. Provider business mailing address

6103 WILKINSON AVE
NORTH HOLLYWOOD CA
91606-4517
US

V. Phone/Fax

Practice location:
  • Phone: 310-390-6612
  • Fax: 310-398-5690
Mailing address:
  • Phone: 818-720-2436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number148464
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: