Provider Demographics
NPI:1306844303
Name:HERRERA, MAURICIO FERNANDO (MD)
Entity Type:Individual
Prefix:
First Name:MAURICIO
Middle Name:FERNANDO
Last Name:HERRERA
Suffix:
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 1:11801 SW 90TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-2182
Mailing Address - Country:US
Mailing Address - Phone:305-595-1317
Mailing Address - Fax:305-279-6813
Practice Address - Street 1:11801 SW 90TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-2182
Practice Address - Country:US
Practice Address - Phone:305-595-1317
Practice Address - Fax:305-279-6813
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME-88609207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL48298ZMedicare PIN