Provider Demographics
NPI:1356466601
Name:HERRERA, JESUS RENE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:RENE
Last Name:HERRERA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 CHILDRENS WAY
Mailing Address - Street 2:MC 5014
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4223
Mailing Address - Country:US
Mailing Address - Phone:858-966-4011
Mailing Address - Fax:858-278-2365
Practice Address - Street 1:3020 CHILDRENS WAY
Practice Address - Street 2:CITIBANK BUILDING
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4223
Practice Address - Country:US
Practice Address - Phone:858-966-4011
Practice Address - Fax:858-278-2365
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 20584103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical