Provider Demographics
NPI:1972764207
Name:HERRERA, GABRIELA (MS)
Entity Type:Individual
Prefix:MRS
First Name:GABRIELA
Middle Name:
Last Name:HERRERA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:GABRIELA
Other - Middle Name:
Other - Last Name:MIRAMONTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 E GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92415-1769
Mailing Address - Country:US
Mailing Address - Phone:909-386-0785
Mailing Address - Fax:
Practice Address - Street 1:900 E GILBERT ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92415-0460
Practice Address - Country:US
Practice Address - Phone:909-463-7623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55436106H00000X
CAMFC 49933106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist