Provider Demographics
NPI:1114466935
Name:MURATI HERRERA, GIAN CARLO (OD)
Entity Type:Individual
Prefix:DR
First Name:GIAN
Middle Name:CARLO
Last Name:MURATI HERRERA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:L7 CALLE TERRACE
Mailing Address - Street 2:GARDEN HILLS
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-2120
Mailing Address - Country:US
Mailing Address - Phone:787-504-2030
Mailing Address - Fax:
Practice Address - Street 1:L7 CALLE TER
Practice Address - Street 2:GARDEN HILLS
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966
Practice Address - Country:US
Practice Address - Phone:787-504-2030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR725152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR725OtherOPTOMETRY LICENSE