Healthcare Provider Details

I. General information

NPI: 1578905519
Provider Name (Legal Business Name): HERENIA SHEPHERD PPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2013
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50200 SCHOOL RD
OAKHURST CA
93644-9506
US

IV. Provider business mailing address

55110 LOS PINOS LN
WISHON CA
93669-9731
US

V. Phone/Fax

Practice location:
  • Phone: 559-683-4842
  • Fax:
Mailing address:
  • Phone: 559-930-6881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number210071056
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: