Provider Demographics
NPI:1043424559
Name:JORGE A HERRERA PHD PA
Entity Type:Organization
Organization Name:JORGE A HERRERA PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:305-445-3222
Mailing Address - Street 1:PO BOX 142064
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33114-2064
Mailing Address - Country:US
Mailing Address - Phone:786-314-5644
Mailing Address - Fax:786-314-5677
Practice Address - Street 1:1378 CORAL WAY
Practice Address - Street 2:SUITE 500
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2943
Practice Address - Country:US
Practice Address - Phone:305-445-3222
Practice Address - Fax:305-529-8510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3733103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75780OtherBC BS FL