Provider Demographics
NPI:1538465612
Name:HERRERA-BERNAL, NATHANIEL REY
Entity Type:Individual
Prefix:MR
First Name:NATHANIEL
Middle Name:REY
Last Name:HERRERA-BERNAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 W SHAW AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3234
Mailing Address - Country:US
Mailing Address - Phone:559-275-1784
Mailing Address - Fax:
Practice Address - Street 1:3435 W SHAW AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3234
Practice Address - Country:US
Practice Address - Phone:559-275-1784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor