Provider Demographics
NPI:1063293058
Name:HERRERA, CORRINA SHASTINA (BHIM)
Entity type:Individual
Prefix:
First Name:CORRINA
Middle Name:SHASTINA
Last Name:HERRERA
Suffix:
Gender:F
Credentials:BHIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9434 TECH CENTER DR.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826
Mailing Address - Country:US
Mailing Address - Phone:916-516-4726
Mailing Address - Fax:
Practice Address - Street 1:9434 TECH CENTER DR.
Practice Address - Street 2:SUITE 200
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826
Practice Address - Country:US
Practice Address - Phone:916-516-4726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-06
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information