Healthcare Provider Details

I. General information

NPI: 1629566609
Provider Name (Legal Business Name): MALENI HERRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2018
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1999 HARRISON ST
OAKLAND CA
94612-3520
US

IV. Provider business mailing address

67 CARR ST
SAN FRANCISCO CA
94124-3134
US

V. Phone/Fax

Practice location:
  • Phone: 916-729-3098
  • Fax:
Mailing address:
  • Phone: 415-794-8987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: