Provider Demographics
NPI:1649499542
Name:HERRERA, TANYA
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:HERRERA
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 1:20 CLAUSEN RD
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-5504
Mailing Address - Country:US
Mailing Address - Phone:831-254-5788
Mailing Address - Fax:
Practice Address - Street 1:18 W LAKE AVE
Practice Address - Street 2:SUITE G
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-4537
Practice Address - Country:US
Practice Address - Phone:831-763-4694
Practice Address - Fax:831-763-4693
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD1562820OtherDRIVER'S LICENSE