Active NPI
Mike Herrera III
- Prevention Professional
- Baker, CA
National Provider Identifier
1245050897
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prevention Professional
- License
- 360159AP
- Practice address
- 57131 Lakeview Rd
Baker, CA 92309 - Phone
- (909) 389-8582
- NPI assigned
- Oct 16, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prevention Professional | 405300000X | 360159AP | CA | Primary |
Addresses
Primary practice location
57131 Lakeview Rd
Baker, CA 92309
Mailing address
1366 Whitewood Dr
Mentone, CA 92359-1623
Phone (909) 389-8582
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 360159AP | CA | MD | Prevention Professional |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Serenity Cottages of the Desert | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Substance Use Disorder Rehabilitation Clinic/Center
- Baker, CA
- NPI 1831845510
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1729036800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1729036800000",
"number": "1245050897",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1366 WHITEWOOD DR",
"city": "MENTONE",
"state": "CA",
"postal_code": "923591623",
"telephone_number": "909-389-8582"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "57131 LAKEVIEW RD",
"city": "BAKER",
"state": "CA",
"postal_code": "92309",
"telephone_number": "909-389-8582"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERRERA",
"first_name": "MIKE",
"name_prefix": "Mr.",
"name_suffix": "III",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-10-16",
"last_updated": "2024-10-16",
"certification_date": "2024-10-09",
"status": "A"
},
"taxonomies": [
{
"code": "405300000X",
"taxonomy_group": "",
"desc": "Prevention Professional",
"state": "CA",
"license": "360159AP",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baker, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.