Provider Demographics
NPI:1831503986
Name:HERRERA, JULIA
Entity type:Individual
Prefix:
First Name:JULIA
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 1:2100 N SEPULVEDA BLVD STE 31
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-2958
Mailing Address - Country:US
Mailing Address - Phone:310-251-4170
Mailing Address - Fax:
Practice Address - Street 1:2100 N SEPULVEDA BLVD STE 31
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-2958
Practice Address - Country:US
Practice Address - Phone:310-251-4170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87566106H00000X
CA121358106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist