Provider Demographics
NPI:1245534056
Name:HERRERA, JENNIFER MARIE (PA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
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 1:710 N EUCLID ST
Mailing Address - Street 2:STE 400
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-4122
Mailing Address - Country:US
Mailing Address - Phone:714-517-2000
Mailing Address - Fax:714-490-1975
Practice Address - Street 1:710 N EUCLID ST
Practice Address - Street 2:STE 400
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-4122
Practice Address - Country:US
Practice Address - Phone:714-517-2000
Practice Address - Fax:714-490-1975
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52193363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant