Provider Demographics
NPI:1205077690
Name:PANIAGUA, HERICA
Entity type:Individual
Prefix:
First Name:HERICA
Middle Name:
Last Name:PANIAGUA
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 1:4000 LONG BEACH BLVD # 228
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2617
Mailing Address - Country:US
Mailing Address - Phone:562-426-3300
Mailing Address - Fax:562-637-3244
Practice Address - Street 1:4000 LONG BEACH BLVD # 228
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2617
Practice Address - Country:US
Practice Address - Phone:562-426-3300
Practice Address - Fax:562-637-3244
Is Sole Proprietor?:No
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor