Provider Demographics
NPI:1760201552
Name:HERRERA, VIVIAN ELIZABETH (MED)
Entity type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:ELIZABETH
Last Name:HERRERA
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12215 TELEGRAPH RD STE 210A
Mailing Address - Street 2:
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-3344
Mailing Address - Country:US
Mailing Address - Phone:562-286-6925
Mailing Address - Fax:
Practice Address - Street 1:12215 TELEGRAPH RD STE 210A
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-3344
Practice Address - Country:US
Practice Address - Phone:562-286-6925
Practice Address - Fax:626-612-8895
Is Sole Proprietor?:No
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst