Provider Demographics
NPI:1003148651
Name:HERRERA, VICTORIA (BA (DUAL))
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:HERRERA
Suffix:
Gender:F
Credentials:BA (DUAL)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4312 CARLISLE BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-4811
Mailing Address - Country:US
Mailing Address - Phone:505-323-3785
Mailing Address - Fax:505-323-3850
Practice Address - Street 1:4312 CARLISLE BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4811
Practice Address - Country:US
Practice Address - Phone:505-323-3785
Practice Address - Fax:505-323-3850
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator