Healthcare Provider Details

I. General information

NPI: 1639465891
Provider Name (Legal Business Name): ROCIO ROSE HERRERA PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2011
Last Update Date: 06/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2837 KNOX AVE
LOS ANGELES CA
90039-3424
US

IV. Provider business mailing address

2837 KNOX AVE
LOS ANGELES CA
90039-3424
US

V. Phone/Fax

Practice location:
  • Phone: 714-865-4914
  • Fax:
Mailing address:
  • Phone: 714-865-4914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number8076
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: