Individual
ANGEL HEREDIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
425 E SANTA CLARA ST, SAN JOSE, CA 95113-1936
(408) 800-4095
Mailing address
425 E. TAYLOR STREET, SAN JOSE, CA 95113
(408) 800-4095
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
06/10/2021
Last updated
06/30/2025
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