Provider Demographics
NPI:1346559564
Name:HERRERA, JUSTIN RUBEN (CAP, CAC III PENDING)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:RUBEN
Last Name:HERRERA
Suffix:
Gender:M
Credentials:CAP, CAC III PENDING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1290 CHAMBERS RD
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-7117
Mailing Address - Country:US
Mailing Address - Phone:303-617-2715
Mailing Address - Fax:303-617-2734
Practice Address - Street 1:1290 CHAMBERS RD
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-7117
Practice Address - Country:US
Practice Address - Phone:303-617-2715
Practice Address - Fax:303-617-2734
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator