Healthcare Provider Details

I. General information

NPI: 1407728751
Provider Name (Legal Business Name): JOHN THOMAS HERRERA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2025
Last Update Date: 09/18/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 W CHANNEL ISLANDS BLVD
OXNARD CA
93035-4001
US

IV. Provider business mailing address

117 LOS ANGELES AVE
OXNARD CA
93035-4629
US

V. Phone/Fax

Practice location:
  • Phone: 805-827-4914
  • Fax:
Mailing address:
  • Phone: 805-827-4914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCI-32290321
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number9BF2513B53
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-MRDHNE
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: