Provider Demographics
NPI:1699517417
Name:HERRERA, GINALYN (PPS CREDENTIAL)
Entity type:Individual
Prefix:MRS
First Name:GINALYN
Middle Name:
Last Name:HERRERA
Suffix:
Gender:F
Credentials:PPS CREDENTIAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42945 AMOY ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-4644
Mailing Address - Country:US
Mailing Address - Phone:661-592-0124
Mailing Address - Fax:
Practice Address - Street 1:42945 AMOY ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-4644
Practice Address - Country:US
Practice Address - Phone:661-592-0124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool