Provider Demographics
NPI:1336119684
Name:HERRERA, RUDY B (DC, FNP)
Entity Type:Individual
Prefix:DR
First Name:RUDY
Middle Name:B
Last Name:HERRERA
Suffix:
Gender:M
Credentials:DC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5397 TRUXTUN AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0641
Mailing Address - Country:US
Mailing Address - Phone:661-634-9900
Mailing Address - Fax:661-634-0973
Practice Address - Street 1:1217 7TH ST
Practice Address - Street 2:
Practice Address - City:WASCO
Practice Address - State:CA
Practice Address - Zip Code:93280-1820
Practice Address - Country:US
Practice Address - Phone:661-725-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21359111N00000X
CAF1212429363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF1212429OtherFNP
CAU24305Medicare UPIN