Provider Demographics
NPI:1003462268
Name:HERRERA, RONNY RODOLFO
Entity Type:Individual
Prefix:
First Name:RONNY
Middle Name:RODOLFO
Last Name:HERRERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BEACON EXECUTIVE SUITES, 8359 BEACON BLVD
Mailing Address - Street 2:SUITE#416
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33907
Mailing Address - Country:US
Mailing Address - Phone:239-529-0957
Mailing Address - Fax:
Practice Address - Street 1:BEACON EXECUTIVE SUITES, 8359 BEACON BLVD
Practice Address - Street 2:SUITE#416
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33907
Practice Address - Country:US
Practice Address - Phone:239-529-0957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician