Healthcare Provider Details

I. General information

NPI: 1609994698
Provider Name (Legal Business Name): SANDRA HERRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 CORPORATE CENTER DR SUITE 650
MONTEREY PARK CA
91754
US

IV. Provider business mailing address

1434 N CALIFORNIA AVE APT. 9
LA PUENTE CA
91744-1025
US

V. Phone/Fax

Practice location:
  • Phone: 323-526-4016
  • Fax:
Mailing address:
  • Phone: 626-559-4428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW83428
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: