Provider Demographics
NPI:1164618542
Name:HERRERA, ROGELIO (LMP)
Entity Type:Individual
Prefix:
First Name:ROGELIO
Middle Name:
Last Name:HERRERA
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 116TH AVE NE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3010
Mailing Address - Country:US
Mailing Address - Phone:425-467-5625
Mailing Address - Fax:425-467-5627
Practice Address - Street 1:1601 116TH AVE NE
Practice Address - Street 2:SUITE 111
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3010
Practice Address - Country:US
Practice Address - Phone:425-467-5625
Practice Address - Fax:425-467-5627
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018284225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA00018284OtherSTATE LICENSE