Basic Information
| Provider Information | |||||||||
| NPI: | 1285818187 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERRERA | ||||||||
| FirstName: | BLANCA | ||||||||
| MiddleName: | ALICIA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1908 CIENEGA AVE | ||||||||
| Address2: | APT. 204 | ||||||||
| City: | COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263310135 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2990 E. INLAND EMPIRE BLVD. | ||||||||
| Address2: | STE. 101 | ||||||||
| City: | ONTARIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099803427 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2007 | ||||||||
| LastUpdateDate: | 01/15/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.