Provider Demographics
NPI:1225674609
Name:HERREN, PAUL VINCENT
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:VINCENT
Last Name:HERREN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2543 CITRUS LN
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-4902
Mailing Address - Country:US
Mailing Address - Phone:480-205-8982
Mailing Address - Fax:
Practice Address - Street 1:2543 CITRUS LN
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-4902
Practice Address - Country:US
Practice Address - Phone:928-412-3847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCNM8581347C00000X
AZ12A39B343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle