Basic Information
| Provider Information | |||||||||
| NPI: | 1891830014 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERRERA | ||||||||
| FirstName: | ELMER | ||||||||
| MiddleName: | IVAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16112 HALDANE ST | ||||||||
| Address2: | |||||||||
| City: | WHITTIER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906032814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232058435 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8825 WHITTIER BLVD | ||||||||
| Address2: | |||||||||
| City: | PICO RIVERA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906602657 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626993333 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2007 | ||||||||
| LastUpdateDate: | 06/01/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 88916 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.