Healthcare Provider Details

I. General information

NPI: 1104383678
Provider Name (Legal Business Name): TONIA NALEEN HERRERO MPS, ATR-BC, LCAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2019
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 SANTA CLARA AVE STE 220
OAKLAND CA
94610-1375
US

IV. Provider business mailing address

55 SANTA CLARA AVE STE 220
OAKLAND CA
94610-1375
US

V. Phone/Fax

Practice location:
  • Phone: 510-675-7070
  • Fax:
Mailing address:
  • Phone: 510-675-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number18-101
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: