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General NPI Number Information
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NPI Number | 1386751816
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Entity Type | Individual
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Provider Name | RANDY ALLEN HERRERA HONDO PT
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Gender | Male
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 12/13/2021
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Provider Practice Location Address
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Address Line | 11100 WARNER AVE SUITE 218
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-7506
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Country | US
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Telephone | 714-424-0290
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Fax | 714-424-0278
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Provider Business Mailing Address
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Address Line | 149 W DESFORD ST
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City | CARSON
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State | CA
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Zip | 90745-1412
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Country | US
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Telephone | 714-424-0290
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Fax | 714-424-0278
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT24918
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License Number State | CA
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