Healthcare Provider Details

I. General information

NPI: 1922218148
Provider Name (Legal Business Name): JOHN S HERRERA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5342 DUDLEY BLVD
MCCLELLAN CA
95652-1012
US

IV. Provider business mailing address

3409 MITCHELL ST
MCCLELLAN CA
95652-1011
US

V. Phone/Fax

Practice location:
  • Phone: 916-643-7676
  • Fax: 916-643-7700
Mailing address:
  • Phone: 916-643-7676
  • Fax: 916-643-7700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: