Healthcare Provider Details

I. General information

NPI: 1396055067
Provider Name (Legal Business Name): RIANNE JEAN HERRERA MA, NBCT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RIANNE JEAN VENTURA MA, NBCT

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 10/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11513 SAN JACINTO AVE NE
ALBUQUERQUE NM
87112-5528
US

IV. Provider business mailing address

11513 SAN JACINTO AVE NE
ALBUQUERQUE NM
87112-5528
US

V. Phone/Fax

Practice location:
  • Phone: 505-480-1860
  • Fax:
Mailing address:
  • Phone: 505-480-1860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: