Provider Demographics
NPI:1760161400
Name:HERRERA, DAVINA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:DAVINA
Middle Name:
Last Name:HERRERA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 SW HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-3120
Mailing Address - Country:US
Mailing Address - Phone:541-604-5365
Mailing Address - Fax:
Practice Address - Street 1:716 SW HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-3120
Practice Address - Country:US
Practice Address - Phone:541-604-5365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist