Provider Demographics
NPI:1568772085
Name:HERRERA GUTIERREZ, MARGARITA IVONNE
Entity Type:Individual
Prefix:MISS
First Name:MARGARITA
Middle Name:IVONNE
Last Name:HERRERA GUTIERREZ
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 1:5416 HOLDENER ROAD
Mailing Address - Street 2:PO BOX 590
Mailing Address - City:ELMIRA
Mailing Address - State:CA
Mailing Address - Zip Code:95625
Mailing Address - Country:US
Mailing Address - Phone:707-453-6227
Mailing Address - Fax:
Practice Address - Street 1:5416 HOLDENER ROAD
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:CA
Practice Address - Zip Code:95625
Practice Address - Country:US
Practice Address - Phone:707-453-6227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool