Provider Demographics
NPI:1366863334
Name:HERRERA, ELSY
Entity type:Individual
Prefix:
First Name:ELSY
Middle Name:
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 1:2213 BUCHANAN RD STE 101-103
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-4265
Mailing Address - Country:US
Mailing Address - Phone:510-460-5560
Mailing Address - Fax:925-709-3431
Practice Address - Street 1:2648 INTERNATIONAL BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-1506
Practice Address - Country:US
Practice Address - Phone:510-903-7521
Practice Address - Fax:510-437-8955
Is Sole Proprietor?:No
Enumeration Date:2013-12-18
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker