Provider Demographics
NPI:1306017280
Name:HERRERA, GUSTAVO D
Entity Type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:D
Last Name:HERRERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1885 LUNDY AVE
Mailing Address - Street 2:SUITE #223
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-1887
Mailing Address - Country:US
Mailing Address - Phone:408-503-7985
Mailing Address - Fax:408-503-7995
Practice Address - Street 1:1200 CONCORD AVE STE 3100
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-4915
Practice Address - Country:US
Practice Address - Phone:509-818-4943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health