MEDICARE: MRS. SANDRA MARCELA HERRERA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	CPT8635	CA
2	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CPT8635	OTHER	CA	PHLEBOTOMIST

General Provider Information

NPI Number	:	1174655773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SANDRA MARCELA HERRERA

Provider Business Mailing Address
First Line	:	3050 BEACON BLVD STE 103
Second Line	:
City	:	WEST SACRAMENTO
State	:	CA
Zip	:	95691-3467
Country	:	US
Telephone Number	:	530-230-1285
Fax Number	:

Provider Business Practice Location Address
First Line	:	3050 BEACON BLVD STE 103
Second Line	:
City	:	WEST SACRAMENTO
State	:	CA
Zip	:	95691-3467
Country	:	US
Telephone Number	:	530-230-1285
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	10/11/2018

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