Healthcare Provider Details

I. General information

NPI: 1578642062
Provider Name (Legal Business Name): MR. HERBERT ANDERSON JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 05/22/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10605 BALBOA BLVD SUITE 100
GRANADA HILLS CA
91344-6342
US

IV. Provider business mailing address

10605 BALBOA BLVD SUITE 100
GRANADA HILLS CA
91344-6342
US

V. Phone/Fax

Practice location:
  • Phone: 818-832-2400
  • Fax: 818-832-2518
Mailing address:
  • Phone: 818-832-2400
  • Fax: 818-832-2567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: