MEDICARE: GUSTAVO D 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1306017280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUSTAVO D HERRERA

Provider Business Mailing Address
First Line	:	1885 LUNDY AVE
Second Line	:	SUITE #223
City	:	SAN JOSE
State	:	CA
Zip	:	95131-1887
Country	:	US
Telephone Number	:	408-503-7985
Fax Number	:	408-503-7995

Provider Business Practice Location Address
First Line	:	1200 CONCORD AVE STE 3100
Second Line	:
City	:	CONCORD
State	:	CA
Zip	:	94520-4915
Country	:	US
Telephone Number	:	509-818-4943
Fax Number	:

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

Provider Enumeration Date	:	03/18/2008
Last Update Date	:	04/13/2023

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Directions to “ GUSTAVO D HERRERA ” Practice Location

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