Provider Demographics
NPI:1306714803
Name:HERRERA, DIEGO JESUS
Entity type:Individual
Prefix:
First Name:DIEGO
Middle Name:JESUS
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 1:430 MOUNTAIN AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:07974-2731
Mailing Address - Country:US
Mailing Address - Phone:973-299-9954
Mailing Address - Fax:
Practice Address - Street 1:1300 SONYA LN
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-6322
Practice Address - Country:US
Practice Address - Phone:805-361-4530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-27
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADCCC18F4EC171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach