Provider Demographics
NPI:1558542951
Name:HERRERA, REYNA RODRIGUEZ GARC (SUDCC II)
Entity Type:Individual
Prefix:
First Name:REYNA RODRIGUEZ GARC
Middle Name:
Last Name:HERRERA
Suffix:
Gender:F
Credentials:SUDCC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 PALOMAR ST STE A
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-4207
Mailing Address - Country:US
Mailing Address - Phone:619-498-0908
Mailing Address - Fax:619-498-0954
Practice Address - Street 1:2414 HOOVER AVE STE A
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-8582
Practice Address - Country:US
Practice Address - Phone:161-336-1226
Practice Address - Fax:619-477-1052
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)