Provider Demographics
NPI:1962700104
Name:HERRERA, MARY KATHLEEN (FNPC)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KATHLEEN
Last Name:HERRERA
Suffix:
Gender:F
Credentials:FNPC
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Mailing Address - Street 1:23823 VALENCIA BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-9512
Mailing Address - Country:US
Mailing Address - Phone:661-254-0026
Mailing Address - Fax:661-254-1773
Practice Address - Street 1:23823 VALENCIA BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-9512
Practice Address - Country:US
Practice Address - Phone:661-254-0026
Practice Address - Fax:661-254-1773
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-12
Last Update Date:2015-08-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CANP6695363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily