Provider Demographics
NPI:1336822444
Name:HERRERA, JHON (DPT)
Entity Type:Individual
Prefix:DR
First Name:JHON
Middle Name:
Last Name:HERRERA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:JHON HERRERA
Other - Middle Name:
Other - Last Name:KHALIFE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1924 W CATALPA AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-3516
Mailing Address - Country:US
Mailing Address - Phone:408-590-6642
Mailing Address - Fax:
Practice Address - Street 1:1101 S ANAHEIM BLVD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-5811
Practice Address - Country:US
Practice Address - Phone:714-937-1919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA304565225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist