Provider Demographics
NPI:1962642082
Name:HERRERA, AMITY ELISE (PA)
Entity Type:Individual
Prefix:
First Name:AMITY
Middle Name:ELISE
Last Name:HERRERA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E REDLANDS BLVD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4775
Mailing Address - Country:US
Mailing Address - Phone:909-335-7649
Mailing Address - Fax:909-557-1953
Practice Address - Street 1:4488 S PECOS RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5030
Practice Address - Country:US
Practice Address - Phone:702-436-1001
Practice Address - Fax:702-436-7999
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA905363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVPA905OtherP.A. LICENSE
NVBN382YMedicare PIN
NVPA905OtherP.A. LICENSE