Healthcare Provider Details

I. General information

NPI: 1588520647
Provider Name (Legal Business Name): TRACEY DANIELLE HERRERA PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2026
Last Update Date: 01/01/2026
Certification Date: 01/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 N GLENDALE AVE # 1116
GLENDALE CA
91206-4455
US

IV. Provider business mailing address

213 N GLENDALE AVE # 1116
GLENDALE CA
91206-4455
US

V. Phone/Fax

Practice location:
  • Phone: 323-332-7643
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95037218
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: