Healthcare Provider Details

I. General information

NPI: 1730887886
Provider Name (Legal Business Name): ABIGAIL ROSE HERRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2023
Last Update Date: 02/17/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4505 S MARYLAND PKWY
LAS VEGAS NV
89154-9900
US

IV. Provider business mailing address

7017 S BUFFALO DR APT 1140
LAS VEGAS NV
89113-4099
US

V. Phone/Fax

Practice location:
  • Phone: 702-895-3011
  • Fax:
Mailing address:
  • Phone: 775-815-2343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: