Provider Demographics
NPI:1669364345
Name:HERRERA, SANDRA (REGISTERED DIETITIAN)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:HERRERA
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:HERRERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED DIETITIAN
Mailing Address - Street 1:290 N WAYTE LN STE 1300
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93701-2124
Mailing Address - Country:US
Mailing Address - Phone:559-354-9077
Mailing Address - Fax:
Practice Address - Street 1:290 N WAYTE LN STE 1300
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-2124
Practice Address - Country:US
Practice Address - Phone:559-354-9077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered