Provider Demographics
NPI:1346409034
Name:HERRERA, SANTIAGO (MD)
Entity Type:Individual
Prefix:DR
First Name:SANTIAGO
Middle Name:
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 1:5212 PRESTON PKWY W
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-7161
Mailing Address - Country:US
Mailing Address - Phone:215-459-1149
Mailing Address - Fax:
Practice Address - Street 1:2109 HUGHES DR STE 400
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-5143
Practice Address - Country:US
Practice Address - Phone:419-291-2080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH095890390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program