Healthcare Provider Details

I. General information

NPI: 1821923905
Provider Name (Legal Business Name): JUAN HERRERA PSS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 BROADWAY ST NE
SALEM OR
97301-1141
US

IV. Provider business mailing address

830 IRONWOOD DR SE
SALEM OR
97306-1617
US

V. Phone/Fax

Practice location:
  • Phone: 503-393-4273
  • Fax: 503-218-0515
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number116817
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: