Provider Demographics
NPI:1407237498
Name:HERRERA, NATALIE KATHLEEN (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:NATALIE
Middle Name:KATHLEEN
Last Name:HERRERA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7475 LANGDON AVE
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-7317
Mailing Address - Country:US
Mailing Address - Phone:760-221-8362
Mailing Address - Fax:
Practice Address - Street 1:16456 SIERRA LAKES PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336
Practice Address - Country:US
Practice Address - Phone:909-429-2864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52564363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant