Provider Demographics
NPI:1053879122
Name:HERRERA, ANDREA ALEJANDRA
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:ALEJANDRA
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 1:15760 VENTURA BLVD STE 1060
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-3065
Mailing Address - Country:US
Mailing Address - Phone:818-788-2388
Mailing Address - Fax:
Practice Address - Street 1:15760 VENTURA BLVD STE 1060
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-3065
Practice Address - Country:US
Practice Address - Phone:818-788-2388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-07
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1124271614OtherTHERAPY OFFICE