Provider Demographics
NPI:1407495591
Name:HERRERA, JOHN VINCENT (SLPA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:VINCENT
Last Name:HERRERA
Suffix:
Gender:M
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 S 228TH LN
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-7135
Mailing Address - Country:US
Mailing Address - Phone:623-225-5594
Mailing Address - Fax:
Practice Address - Street 1:14825 N 54TH PL
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-2369
Practice Address - Country:US
Practice Address - Phone:480-242-5903
Practice Address - Fax:602-218-6462
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA12216175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath