Provider Demographics
NPI:1083377535
Name:VACA, HERLINDA
Entity Type:Individual
Prefix:
First Name:HERLINDA
Middle Name:
Last Name:VACA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 S MEADOWBROOK DR APT 26A
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-7651
Mailing Address - Country:US
Mailing Address - Phone:619-451-2458
Mailing Address - Fax:
Practice Address - Street 1:360 S MEADOWBROOK DR APT 26A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-7651
Practice Address - Country:US
Practice Address - Phone:619-451-2458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA002076176374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty