Healthcare Provider Details

I. General information

NPI: 1710699426
Provider Name (Legal Business Name): MS. NATHALIE HERRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2022
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 CENTRAL AVE
FILLMORE CA
93015-1920
US

IV. Provider business mailing address

1040 FLYNN RD
CAMARILLO CA
93012-5092
US

V. Phone/Fax

Practice location:
  • Phone: 805-524-4926
  • Fax: 805-524-4137
Mailing address:
  • Phone: 805-673-3930
  • Fax: 805-659-3217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA66701
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: