Basic Information
| Provider Information | |||||||||
| NPI: | 1811351372 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERRERA | ||||||||
| FirstName: | RUBY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4801 HAYDEN PL NW | ||||||||
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| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871203227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9152749068 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1709 MOON ST NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871123935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052710329 | ||||||||
| FaxNumber: | 5052714957 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2016 | ||||||||
| LastUpdateDate: | 04/18/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | N | Agencies | Case Management | 101YM0800X | CMH0197301 | NM | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.