1972635902 NPI number — MS. LYNDA C. HERRERA MFT INTERN

Table of content: MS. LYNDA C. HERRERA MFT INTERN (NPI 1972635902)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972635902 NPI number — MS. LYNDA C. HERRERA MFT INTERN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERRERA
Provider First Name:
LYNDA
Provider Middle Name:
C.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MFT INTERN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972635902
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1317 HUNTINGTON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91030-4511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-344-5536
Provider Business Mailing Address Fax Number:
323-344-5550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1317 HUNTINGTON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91030-4511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-344-5536
Provider Business Practice Location Address Fax Number:
323-344-5550
Provider Enumeration Date:
03/13/2007

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: 106H00000X , with the licence number:  77478 , 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)





Copyright © 2007-2024 www.npivalidator.com