Basic Information
| Provider Information | |||||||||
| NPI: | 1053039065 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERRERA-MALDONADO | ||||||||
| FirstName: | VINCENT | ||||||||
| MiddleName: | ANTHONY | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18080 ORANGE WAY | ||||||||
| Address2: | |||||||||
| City: | FONTANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923354159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626566564 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2040 CAMFIELD AVE | ||||||||
| Address2: | |||||||||
| City: | COMMERCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900401502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237258751 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2022 | ||||||||
| LastUpdateDate: | 09/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WG0600X | 95164312 | CA | N | Nursing Service Providers | Registered Nurse | Gerontology | 163WC1600X | 95164312 | CA | Y | Nursing Service Providers | Registered Nurse | Continuing Education/Staff Development | 163W00000X | 95164312 | CA | N | Nursing Service Providers | Registered Nurse | 163WA2000X | 95164312 | CA | N | Nursing Service Providers | Registered Nurse | Administrator |
No ID Information.