Provider Demographics
NPI:1467864991
Name:LUZ A. HERRERA PHYSICIAN ASSISTANT INC
Entity Type:Organization
Organization Name:LUZ A. HERRERA PHYSICIAN ASSISTANT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:A
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:310-922-1096
Mailing Address - Street 1:3855 W 105TH ST
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90303-1812
Mailing Address - Country:US
Mailing Address - Phone:310-922-1096
Mailing Address - Fax:
Practice Address - Street 1:3855 W 105TH ST
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90303-1812
Practice Address - Country:US
Practice Address - Phone:310-922-1096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22843261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center