Provider Demographics
NPI:1821561267
Name:BAG-AO, HERMA JOEY ECHAVEZ (APN)
Entity type:Individual
Prefix:MRS
First Name:HERMA JOEY
Middle Name:ECHAVEZ
Last Name:BAG-AO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 PLEASANT GROVE BLVD
Mailing Address - Street 2:STE 125
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-6194
Mailing Address - Country:US
Mailing Address - Phone:630-915-3467
Mailing Address - Fax:
Practice Address - Street 1:701 PLEASANT GROVE BLVD STE 125
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-6194
Practice Address - Country:US
Practice Address - Phone:916-784-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-08
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010586363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty