Provider Demographics
NPI:1063997948
Name:HERRERA, PRISCILLA SOLIS
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:SOLIS
Last Name:HERRERA
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 1:2212 GATEWAY OAKS DR APT 201
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-4215
Mailing Address - Country:US
Mailing Address - Phone:510-825-6059
Mailing Address - Fax:
Practice Address - Street 1:2212 GATEWAY OAKS DR APT 201
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95833-4215
Practice Address - Country:US
Practice Address - Phone:510-825-6059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-26
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291982164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse