Provider Demographics
NPI:1245592724
Name:HERRERA, JOHANA C
Entity Type:Individual
Prefix:MRS
First Name:JOHANA
Middle Name:C
Last Name:HERRERA
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 1:3318 154TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-3323
Mailing Address - Country:US
Mailing Address - Phone:917-806-4196
Mailing Address - Fax:
Practice Address - Street 1:3318 154TH ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-3323
Practice Address - Country:US
Practice Address - Phone:917-806-4196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist