Provider Demographics
NPI:1538641923
Name:HERRERO, LAUTARO LEONEL
Entity Type:Individual
Prefix:
First Name:LAUTARO
Middle Name:LEONEL
Last Name:HERRERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2632 WINDSOR PL
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-3987
Mailing Address - Country:US
Mailing Address - Phone:956-525-0212
Mailing Address - Fax:
Practice Address - Street 1:2632 WINDSOR PL
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-3987
Practice Address - Country:US
Practice Address - Phone:956-525-0212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2138727225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant