Provider Demographics
NPI:1225897614
Name:HERRERA, MARICELLA JOSEPHINA-JUANITA
Entity Type:Individual
Prefix:
First Name:MARICELLA
Middle Name:JOSEPHINA-JUANITA
Last Name:HERRERA
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 1:17419 W ELAINE DR
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-1982
Mailing Address - Country:US
Mailing Address - Phone:623-432-6555
Mailing Address - Fax:
Practice Address - Street 1:17419 W ELAINE DR
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-1982
Practice Address - Country:US
Practice Address - Phone:623-432-6555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician