Provider Demographics
NPI:1144603366
Name:HERRERA MEDICAL LLC
Entity Type:Organization
Organization Name:HERRERA MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-241-8794
Mailing Address - Street 1:10261 SW 72ND ST
Mailing Address - Street 2:SUITE C105
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3023
Mailing Address - Country:US
Mailing Address - Phone:786-241-8794
Mailing Address - Fax:786-245-6701
Practice Address - Street 1:10261 SW 72ND ST
Practice Address - Street 2:SUITE C105
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3023
Practice Address - Country:US
Practice Address - Phone:786-241-8794
Practice Address - Fax:786-245-6701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty