Healthcare Provider Details

I. General information

NPI: 1376052811
Provider Name (Legal Business Name): MAYRA HERRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2017
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 N RAYMOND AVE BLDG 2-7
PASADENA CA
91103-1819
US

IV. Provider business mailing address

1833 ACKLEY PL
MONTEREY PARK CA
91755-4115
US

V. Phone/Fax

Practice location:
  • Phone: 626-396-5920
  • Fax:
Mailing address:
  • Phone: 805-216-4371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2910
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: