Provider Demographics
NPI:1487771739
Name:HERRINGTON, VALERIE R (DO)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:R
Last Name:HERRINGTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9613 SVL BOX
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-5175
Mailing Address - Country:US
Mailing Address - Phone:760-946-1837
Mailing Address - Fax:
Practice Address - Street 1:19167 HIGHWAY 18
Practice Address - Street 2:#2
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2534
Practice Address - Country:US
Practice Address - Phone:760-946-1837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A65342084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX65340Medicaid
CA330838965-92307-B002OtherTRI CARE
CA00AX65340Medicaid
CA020A65340Medicare ID - Type Unspecified