Provider Demographics
NPI:1760985097
Name:HERRERA, DAISY MARISOL
Entity Type:Individual
Prefix:
First Name:DAISY
Middle Name:MARISOL
Last Name:HERRERA
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 1:1901 ROYAL OAKS DR STE 201
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4235
Mailing Address - Country:US
Mailing Address - Phone:191-692-3178
Mailing Address - Fax:
Practice Address - Street 1:1901 ROYAL OAKS DR STE 201
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4235
Practice Address - Country:US
Practice Address - Phone:916-923-1789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician