Provider Demographics
NPI:1124692488
Name:HERREJON, JANETH E
Entity type:Individual
Prefix:
First Name:JANETH
Middle Name:E
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:PO BOX 1541
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:CA
Mailing Address - Zip Code:93926-1541
Mailing Address - Country:US
Mailing Address - Phone:831-905-8396
Mailing Address - Fax:
Practice Address - Street 1:324 S BELDEN ST
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:CA
Practice Address - Zip Code:93926
Practice Address - Country:US
Practice Address - Phone:831-905-8396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANONE106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA99868287D93060OtherMEDICAL