Provider Demographics
NPI:1356516322
Name:HERREJON, EDITH (BA)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:
Last Name:HERREJON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 W HOSPITALITY LN
Mailing Address - Street 2:STE. 4
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3316
Mailing Address - Country:US
Mailing Address - Phone:909-891-1880
Mailing Address - Fax:909-891-1888
Practice Address - Street 1:164 W HOSPITALITY LN
Practice Address - Street 2:STE. 4
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3316
Practice Address - Country:US
Practice Address - Phone:909-891-1880
Practice Address - Fax:909-891-1888
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor