Provider Demographics
NPI:1639238876
Name:HERAS, PATRICIA (PHD)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:HERAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5665 OBERLIN DR STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1739
Mailing Address - Country:US
Mailing Address - Phone:858-453-9312
Mailing Address - Fax:858-453-9314
Practice Address - Street 1:5665 OBERLIN DR STE 201
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1739
Practice Address - Country:US
Practice Address - Phone:858-453-9312
Practice Address - Fax:858-453-9314
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 9788103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP 9788Medicare ID - Type Unspecified