GERROD HERNDON SUDRC #15464 NPI 1689368615

NPI Information

NPI: 1689368615
Provider Name: GERROD HERNDON, SUDRC #15464
Classification: Clinic/Center - 261QR0405X
Entity Type: Individual

Specialization: Rehabilitation, Substance Use Disorder

Address:
603 D ST
SAN RAFAEL, CA
ZIP 94901
Phone: (707) 331-5575
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Gerrod Herndon, SUDRC #15464 is a rehabilitation and substance use disorder clinic center in San Rafael, CA. Gerrod Herndon, SUDRC #15464 NPI is 1689368615. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

603 D ST
SAN RAFAEL, CA
ZIP 94901-719
Phone: (707) 331-5575

The enumeration date for this NPI number is 6/5/2023 and was last updated on 6/5/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder	15464	CALIFORNIA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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