Provider Demographics
NPI:1497073704
Name:HERRERA-GARCIA, GUADALUPE (DO)
Entity Type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:
Last Name:HERRERA-GARCIA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:GUADALUPE
Other - Middle Name:
Other - Last Name:HERRERA GARCIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1661 E CAMELBACK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-3913
Mailing Address - Country:US
Mailing Address - Phone:602-422-9000
Mailing Address - Fax:602-556-5951
Practice Address - Street 1:3815 S VAL VISTA DR STE 102
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-7309
Practice Address - Country:US
Practice Address - Phone:480-684-1692
Practice Address - Fax:602-556-5951
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP25290207V00000X
AZ007200207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ260823Medicaid