Healthcare Provider Details

I. General information

NPI: 1619251998
Provider Name (Legal Business Name): MR. JAVIER HERRERA JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2011
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6160 MISSION GORGE RD # 206
SAN DIEGO CA
92120-3410
US

IV. Provider business mailing address

6160 MISSION GORGE RD # 206
SAN DIEGO CA
92120-3410
US

V. Phone/Fax

Practice location:
  • Phone: 619-250-1703
  • Fax:
Mailing address:
  • Phone: 619-250-1703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number374700013
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: