Provider Demographics
NPI:1902170681
Name:HERRERA, LILIANA (RN, PHN)
Entity Type:Individual
Prefix:
First Name:LILIANA
Middle Name:
Last Name:HERRERA
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 E GONZALES RD
Mailing Address - Street 2:ST. 102
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-3707
Mailing Address - Country:US
Mailing Address - Phone:805-509-9481
Mailing Address - Fax:
Practice Address - Street 1:2220 E GONZALES RD
Practice Address - Street 2:ST. 102
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-3707
Practice Address - Country:US
Practice Address - Phone:805-981-5115
Practice Address - Fax:805-981-5385
Is Sole Proprietor?:No
Enumeration Date:2012-02-28
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA768687163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse