Provider Demographics
NPI:1801339437
Name:HERRERA, LEIDY JUDITH
Entity type:Individual
Prefix:
First Name:LEIDY
Middle Name:JUDITH
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 1:12502 S WILLOWBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90222-1526
Mailing Address - Country:US
Mailing Address - Phone:323-335-6324
Mailing Address - Fax:
Practice Address - Street 1:3680 E IMPERIAL HWY STE 202
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-2663
Practice Address - Country:US
Practice Address - Phone:323-485-0214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator