Healthcare Provider Details

I. General information

NPI: 1548921380
Provider Name (Legal Business Name): AZRREL ABET HERREJON APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AZRREL ABET HERREJON APCC

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 01/04/2022
Certification Date: 12/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 HIGH ST STE C
DELANO CA
93215-2960
US

IV. Provider business mailing address

828 HIGH ST STE C
DELANO CA
93215-2960
US

V. Phone/Fax

Practice location:
  • Phone: 661-725-2788
  • Fax: 661-725-1957
Mailing address:
  • Phone: 661-725-2788
  • Fax: 661-725-1957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPCC9479
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: