Provider Demographics
NPI:1427696673
Name:HERRERA, WENDY CORINA (DDS)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:CORINA
Last Name:HERRERA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8881 FLETCHER PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3195
Mailing Address - Country:US
Mailing Address - Phone:619-836-2363
Mailing Address - Fax:
Practice Address - Street 1:8881 FLETCHER PKWY STE 220
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3195
Practice Address - Country:US
Practice Address - Phone:619-836-2363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1046321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice