Provider Demographics
NPI:1619686425
Name:HERRERA, MORAIAH JASMIN (LPT)
Entity Type:Individual
Prefix:
First Name:MORAIAH JASMIN
Middle Name:
Last Name:HERRERA
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8626 LOWER SACRAMENTO RD STE 41
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-1835
Mailing Address - Country:US
Mailing Address - Phone:209-554-5188
Mailing Address - Fax:
Practice Address - Street 1:8626 LOWER SACRAMENTO RD STE 41
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-1835
Practice Address - Country:US
Practice Address - Phone:209-478-2487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42383167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician