Provider Demographics
NPI:1285862946
Name:HERANA, NESTOR CORTEZ JR (MD)
Entity Type:Individual
Prefix:
First Name:NESTOR
Middle Name:CORTEZ
Last Name:HERANA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86-260 FARRINGTON HWY, MALAMO OLA CLINIC
Mailing Address - Street 2:WAIANAE COAST COMPREHENSIVE HEALTH CENTER
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792
Mailing Address - Country:US
Mailing Address - Phone:808-697-3490
Mailing Address - Fax:
Practice Address - Street 1:86-260 FARRINGTON HWY, MALAMA OLA CLINIC
Practice Address - Street 2:WAIANAE COAST COMPREHENSIVE HEALTH CENTER
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792
Practice Address - Country:US
Practice Address - Phone:808-697-3490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMDR-5666207R00000X
HIMD 16444207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine