Provider Demographics
NPI:1528645744
Name:HERRERA, LUIS ANGEL (BA - SOCIOLOGY)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:ANGEL
Last Name:HERRERA
Suffix:
Gender:M
Credentials:BA - SOCIOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93638-1514
Mailing Address - Country:US
Mailing Address - Phone:559-598-2620
Mailing Address - Fax:
Practice Address - Street 1:4705 N SONORA AVE STE 113-A
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-3966
Practice Address - Country:US
Practice Address - Phone:559-276-7558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11518101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)