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General NPI Number Information
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NPI Number | 1932015500
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Entity Type | Individual
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Provider Name | MOSES JACOB BERRIOS-HEREDIA LVN
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Gender | Male
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Dates
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Enumeration Date | 08/21/2026
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Last Update Date | 08/21/2026
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Provider Practice Location Address
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Address Line | 1610 ARDEN WAY STE 119
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City | SACRAMENTO
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State | CA
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Zip | 95815-4027
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Country | US
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Telephone | 408-489-7162
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Fax |
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Provider Business Mailing Address
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Address Line | 164 LILY BAY CIR
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City | SACRAMENTO
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State | CA
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Zip | 95834-7764
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Country | US
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Telephone | 408-489-7162
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Fax |
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | VN276908
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | VN276908
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | VN276908
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | VN276908
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License Number State | CA
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