Healthcare Provider Details

I. General information

NPI: 1992422703
Provider Name (Legal Business Name): MARIA JOSE HERRERA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 01/16/2026
Certification Date: 01/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 ROSS AVE STE 101
EL CENTRO CA
92243-3623
US

IV. Provider business mailing address

9373 HAZARD WAY STE 200
SAN DIEGO CA
92123-1226
US

V. Phone/Fax

Practice location:
  • Phone: 760-353-0404
  • Fax: 760-353-0392
Mailing address:
  • Phone: 858-810-8000
  • Fax: 858-268-1911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95022610
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: