Provider Demographics
NPI:1124547989
Name:HERRERO MARZO, ALICIA MARIA
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:MARIA
Last Name:HERRERO MARZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:749 NW ORCHID ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-8312
Mailing Address - Country:US
Mailing Address - Phone:786-487-1814
Mailing Address - Fax:
Practice Address - Street 1:749 NW ORCHID ST
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983
Practice Address - Country:US
Practice Address - Phone:786-487-1814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator