1154470094 NPI number — MRS. DEBRA SUE HERRERA N.P.

Table of content: MRS. DEBRA SUE HERRERA N.P. (NPI 1154470094)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154470094 NPI number — MRS. DEBRA SUE HERRERA N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERRERA
Provider First Name:
DEBRA
Provider Middle Name:
SUE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SILVA
Provider Other First Name:
DEBRA
Provider Other Middle Name:
SUE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1154470094
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMARILLO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93011-0201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-388-8330
Provider Business Mailing Address Fax Number:
805-388-8030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1901 OUTLET CENTER DR
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
OXNARD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93036-0663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-388-8830
Provider Business Practice Location Address Fax Number:
805-388-8030
Provider Enumeration Date:
01/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  16873 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 556393 . This is a "REGISTERED NURSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 2667 . This is a "CLINICAL NURSE SPECIALIST" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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