Provider Demographics
NPI:1508410846
Name:HERRERA MEDICAL GROUP PLLC
Entity Type:Organization
Organization Name:HERRERA MEDICAL GROUP PLLC
Other - Org Name:REGENERATIVE CARE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:A
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-436-7531
Mailing Address - Street 1:571 W MAIN ST STE 120
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-3667
Mailing Address - Country:US
Mailing Address - Phone:972-436-7531
Mailing Address - Fax:972-436-6114
Practice Address - Street 1:1305 AIRPORT FWY STE 302
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-6604
Practice Address - Country:US
Practice Address - Phone:817-283-6995
Practice Address - Fax:817-952-7011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-25
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty