Healthcare Provider Details

I. General information

NPI: 1407414717
Provider Name (Legal Business Name): MRS. YANELY ISABEL HERRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2019
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2085 RUSTIN AVE STE 4
RIVERSIDE CA
92507-2498
US

IV. Provider business mailing address

2085 RUSTIN AVE STE 4
RIVERSIDE CA
92507-2498
US

V. Phone/Fax

Practice location:
  • Phone: 951-955-8000
  • Fax: 951-955-8010
Mailing address:
  • Phone: 951-955-8000
  • Fax: 951-955-8010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: