Healthcare Provider Details

I. General information

NPI: 1275187635
Provider Name (Legal Business Name): ANDREW DAVID HERRERA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 W ARTESIA SQ APT B
GARDENA CA
90248-4773
US

IV. Provider business mailing address

208 E ALHAMBRA RD APT F
ALHAMBRA CA
91801-2555
US

V. Phone/Fax

Practice location:
  • Phone: 800-249-1266
  • Fax:
Mailing address:
  • Phone: 805-263-9823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number305512
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: