Provider Demographics
NPI:1407340920
Name:HERRERA, CHRISTINA (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:
Last Name:HERRERA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10644 SHEEPSHEAD BAY AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89166-8016
Mailing Address - Country:US
Mailing Address - Phone:702-169-0603
Mailing Address - Fax:
Practice Address - Street 1:10105 BANBURRY CROSS DR STE 170
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-6647
Practice Address - Country:US
Practice Address - Phone:543-770-2765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116032017208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0116032017Medicaid