Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | PSY15739 | CA |
N | 103G00000X | Clinical Psychologist | PSY15739 | CA |
N | 103TC0700X | Clinical Psychologist | PSY15739 | CA |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | PSY15739 | CA |
N | 103TF0200X | Forensic Psychologist | PSY15739 | CA |
N | 103TH0004X | Health Psychologist | PSY15739 | CA |
N | 103TM1800X | Intellectual & Developmental Disabilities | PSY15739 | CA |
NPI | 1275782302 |
---|---|
Provider Name | Dr. Guillermo Osvaldo Herrera |
First Address | Santa Fe Springs, CA 90670-2387 |
Second Address | Santa Fe Springs, CA 90670-2387 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2008 |
Last Update Date | 12/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PSY157391 | MEDI-CAL (01) | CA |