Healthcare Provider Details

I. General information

NPI: 1962193037
Provider Name (Legal Business Name): SHELLEY F HERRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHELLEY F DAVIDSON

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 FURUKAWA WAY
SANTA MARIA CA
93458-4929
US

IV. Provider business mailing address

1265 FURUKAWA WAY
SANTA MARIA CA
93458-4929
US

V. Phone/Fax

Practice location:
  • Phone: 805-621-2807
  • Fax:
Mailing address:
  • Phone: 805-614-4940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: