Provider Demographics
NPI:1154470094
Name:HERRERA, DEBRA SUE (NP)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:SUE
Last Name:HERRERA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:DEBRA
Other - Middle Name:SUE
Other - Last Name:SILVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 201
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93011-0201
Mailing Address - Country:US
Mailing Address - Phone:805-388-8330
Mailing Address - Fax:805-388-8030
Practice Address - Street 1:1901 OUTLET CENTER DR
Practice Address - Street 2:SUITE 220
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-0663
Practice Address - Country:US
Practice Address - Phone:805-388-8830
Practice Address - Fax:805-388-8030
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16873363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA556393OtherREGISTERED NURSE
CA2667OtherCLINICAL NURSE SPECIALIST