Provider Demographics
NPI:1407479488
Name:HERRERA, EMILY BELTRAN IX
Entity Type:Individual
Prefix:MISS
First Name:EMILY
Middle Name:BELTRAN
Last Name:HERRERA
Suffix:IX
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:EMILY
Other - Middle Name:JANIS
Other - Last Name:BELTRAN HERRERA
Other - Suffix:III
Other - Last Name Type:Former Name
Other - Credentials:ETC
Mailing Address - Street 1:4501 N CAMINO DEL OBISPO
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-6605
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4501 N CAMINO DEL OBISPO, 85718
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:ARIZONA
Practice Address - Zip Code:85618
Practice Address - Country:AM
Practice Address - Phone:520-202-1109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-25
Last Update Date:2020-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBACB579074103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBACB5709074OtherRBT