Provider Demographics
NPI:1396636262
Name:HERRERA, OLIVIA PAULINA
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:PAULINA
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 1:7944 E LOMA LAND DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-3742
Mailing Address - Country:US
Mailing Address - Phone:480-465-2114
Mailing Address - Fax:
Practice Address - Street 1:15454 N FRANK LLOYD WRIGHT BLVD STE A2
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2090
Practice Address - Country:US
Practice Address - Phone:480-465-2114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23272225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist