Provider Demographics
NPI:1366256117
Name:HERREJON, ANA
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:HERREJON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15760 VENTURA BLVD STE 1060
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-3065
Mailing Address - Country:US
Mailing Address - Phone:818-788-2388
Mailing Address - Fax:
Practice Address - Street 1:15760 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-3000
Practice Address - Country:US
Practice Address - Phone:818-788-2388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-03
Last Update Date:2025-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12478464103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst