Provider Demographics
NPI:1942014261
Name:HEREDIA, TRISTEN H
Entity type:Individual
Prefix:
First Name:TRISTEN
Middle Name:H
Last Name:HEREDIA
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 1:8660 BRENTWOOD BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-5671
Mailing Address - Country:US
Mailing Address - Phone:925-626-7474
Mailing Address - Fax:
Practice Address - Street 1:8660 BRENTWOOD BLVD STE C
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-5671
Practice Address - Country:US
Practice Address - Phone:925-626-7474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA92652355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant