Healthcare Provider Details

I. General information

NPI: 1982936902
Provider Name (Legal Business Name): AMBER JOY HERRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2010
Last Update Date: 02/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 ESTUDILLO AVE
SAN LEANDRO CA
94577-4611
US

IV. Provider business mailing address

545 ESTUDILLO AVE
SAN LEANDRO CA
94577-4611
US

V. Phone/Fax

Practice location:
  • Phone: 510-352-9200
  • Fax: 510-352-8184
Mailing address:
  • Phone: 510-352-9200
  • Fax: 510-352-8184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number27298
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: