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Individual

GERROD HERNDON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
SUDRC #15464

Contact information

Practice address
603 D ST, SAN RAFAEL, CA 94901-3719
(707) 331-5575
Mailing address
603 D ST, SAN RAFAEL, CA 94901-3719
(707) 331-5575

Taxonomy

Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
15464
CA

Other

Enumeration date
06/05/2023
Last updated
06/05/2023
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