Provider Demographics
NPI:1518155290
Name:ALBERTO HERRADA DPM PA
Entity Type:Organization
Organization Name:ALBERTO HERRADA DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRADA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:954-773-6781
Mailing Address - Street 1:10600 GRIFFIN RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3208
Mailing Address - Country:US
Mailing Address - Phone:954-434-9877
Mailing Address - Fax:954-434-9881
Practice Address - Street 1:10600 GRIFFIN RD
Practice Address - Street 2:SUITE 107
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33328-3208
Practice Address - Country:US
Practice Address - Phone:954-434-9877
Practice Address - Fax:954-434-9881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6122620001Medicare NSC
FLAH167Medicare PIN