Provider Demographics
NPI:1144573692
Name:HERRERA, MAESPERANZA SO (PT)
Entity Type:Individual
Prefix:
First Name:MAESPERANZA
Middle Name:SO
Last Name:HERRERA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MAESPERANZA
Other - Middle Name:BALADAD
Other - Last Name:SO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6400 66TH AVE
Mailing Address - Street 2:APT.25
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2735
Mailing Address - Country:US
Mailing Address - Phone:310-619-8065
Mailing Address - Fax:
Practice Address - Street 1:6400 66TH AVE
Practice Address - Street 2:APT.25
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2735
Practice Address - Country:US
Practice Address - Phone:310-619-8065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 30006225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist