Healthcare Provider Details

I. General information

NPI: 1649184821
Provider Name (Legal Business Name): ELISA HERRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 N SUNRISE AVE STE B1
ROSEVILLE CA
95661-2950
US

IV. Provider business mailing address

2945 BELL RD # 274
AUBURN CA
95603-2540
US

V. Phone/Fax

Practice location:
  • Phone: 530-320-5353
  • Fax:
Mailing address:
  • Phone: 530-320-5353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: