Healthcare Provider Details

I. General information

NPI: 1053116129
Provider Name (Legal Business Name): JESUS HERRERA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9455 CLAIREMONT MESA BLVD
SAN DIEGO CA
92123-1297
US

IV. Provider business mailing address

34713 SWAN VALLEY CT
MURRIETA CA
92563-3396
US

V. Phone/Fax

Practice location:
  • Phone: 858-266-4200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number34682
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2278C0205X
TaxonomyCritical Care Certified Respiratory Therapist
License Number34682
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: