Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
GERROD HERNDON, SUDRC #15464
Active Sole ProprietorGERROD HERNDON, SUDRC #15464 is a Substance Use Disorder Rehabilitation Facility healthcare provider located in SAN RAFAEL, California. NPI 1689368615 is currently active in the NPPES registry. Verify at CMS.
Substance Use Disorder Rehabilitation Facility · SAN RAFAEL, CA
Registration Details
- NPI Number
- 1689368615
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Jun 5, 2023 (3.1482160314104 yrs)
- Last Updated
- Jun 5, 2023
- License
-
15464 (CA)
- Sole Proprietor
- Yes
Practice Information
- Address
-
603 D STSAN RAFAEL, CA, 949013719Browse CA providers · Browse ZIP 94901
- Phone
- 7073315575
- Primary Specialty
-
Substance Use Disorder Rehabilitation Facility
261QR0405X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.