Provider Demographics
NPI:1164812855
Name:JOHNSON-HERRERA, ERICA VICTORIA (OT)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:VICTORIA
Last Name:JOHNSON-HERRERA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6424 N RIDGE BLVD APT 2H
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-4832
Mailing Address - Country:US
Mailing Address - Phone:510-277-2145
Mailing Address - Fax:
Practice Address - Street 1:9540 TOWNE CENTRE DR
Practice Address - Street 2:SUITE 150
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1988
Practice Address - Country:US
Practice Address - Phone:858-952-1654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.010629225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation