Healthcare Provider Details

I. General information

NPI: 1376679688
Provider Name (Legal Business Name): RENETTE MARIE HERRERA MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RENETTE MARIE PRICE

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 01/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E GILBERT ST
SAN BERNARDINO CA
92415-1004
US

IV. Provider business mailing address

900 E GILBERT ST
SAN BERNARDINO CA
92415-1004
US

V. Phone/Fax

Practice location:
  • Phone: 909-387-6940
  • Fax: 909-387-7087
Mailing address:
  • Phone: 909-386-0722
  • Fax: 909-386-0750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number49305
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: