Provider Demographics
NPI:1518098607
Name:HERRERA, RADICK ABOLUCION JR (RPT)
Entity Type:Individual
Prefix:MR
First Name:RADICK
Middle Name:ABOLUCION
Last Name:HERRERA
Suffix:JR
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8002 HOLT ST
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-2132
Mailing Address - Country:US
Mailing Address - Phone:562-857-9301
Mailing Address - Fax:
Practice Address - Street 1:1549 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3806
Practice Address - Country:US
Practice Address - Phone:213-381-7479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55327225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist