Provider Demographics
NPI:1376242537
Name:HERDELVA LLC
Entity Type:Organization
Organization Name:HERDELVA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDET
Authorized Official - Prefix:
Authorized Official - First Name:LIGIA
Authorized Official - Middle Name:DONAJI
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-978-2235
Mailing Address - Street 1:8655 DATAPOINT DR APT 108
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3261
Mailing Address - Country:US
Mailing Address - Phone:210-978-2235
Mailing Address - Fax:
Practice Address - Street 1:8655 DATAPOINT DR APT 108
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3261
Practice Address - Country:US
Practice Address - Phone:210-978-2235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care