Healthcare Provider Details

I. General information

NPI: 1326952342
Provider Name (Legal Business Name): GABRIELA HEREDIA CCC-SLP, CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 LA SEDA RD SPC 12D
LA PUENTE CA
91744-6072
US

IV. Provider business mailing address

650 LA SEDA RD SPC 12D
LA PUENTE CA
91744-6072
US

V. Phone/Fax

Practice location:
  • Phone: 281-630-6828
  • Fax:
Mailing address:
  • Phone: 281-630-6828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP40677
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: