Provider Demographics
NPI:1356847990
Name:HERRERA, JOSE CARLOS
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:CARLOS
Last Name:HERRERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6965 HARDING AVE APT 501
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-3250
Mailing Address - Country:US
Mailing Address - Phone:786-378-0941
Mailing Address - Fax:
Practice Address - Street 1:6965 HARDING AVE APT 501
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-3250
Practice Address - Country:US
Practice Address - Phone:786-378-0941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty