Provider Demographics
NPI:1518124767
Name:HERRERA, RAQUEL BERTA (LICENSED DISPENSING)
Entity Type:Individual
Prefix:MS
First Name:RAQUEL
Middle Name:BERTA
Last Name:HERRERA
Suffix:
Gender:F
Credentials:LICENSED DISPENSING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 SW 60TH CT
Mailing Address - Street 2:SUITE #103
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155
Mailing Address - Country:US
Mailing Address - Phone:305-662-8277
Mailing Address - Fax:305-669-6424
Practice Address - Street 1:3200 SW 60TH CT
Practice Address - Street 2:SUITE #103
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155
Practice Address - Country:US
Practice Address - Phone:305-662-8277
Practice Address - Fax:305-669-6424
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO4099156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician