Provider Demographics
NPI:1275892309
Name:VICTOR L. HERRERA, D.P.M., P.A
Entity Type:Organization
Organization Name:VICTOR L. HERRERA, D.P.M., P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-773-5096
Mailing Address - Street 1:4980 PALM AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3726
Mailing Address - Country:US
Mailing Address - Phone:305-512-0080
Mailing Address - Fax:305-512-0082
Practice Address - Street 1:4980 PALM AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3726
Practice Address - Country:US
Practice Address - Phone:305-512-0080
Practice Address - Fax:305-512-0082
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VICTOR L. HERRERA, D.P.M., P.A
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-09
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3517261QA1903X, 261QM2500X, 261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology