Provider Demographics
NPI:1982364022
Name:HERRERA, CAMILA REGINA (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:CAMILA
Middle Name:REGINA
Last Name:HERRERA
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:DR
Other - First Name:CAMILA
Other - Middle Name:REGINA
Other - Last Name:HERRERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ND, LAC
Mailing Address - Street 1:15315 70TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-4605
Mailing Address - Country:US
Mailing Address - Phone:239-849-0369
Mailing Address - Fax:
Practice Address - Street 1:231 BENDIGO BOULEVARD NORTH
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98045
Practice Address - Country:US
Practice Address - Phone:206-651-4136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-29
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC61247114171100000X
WANT61203253175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist