Provider Demographics
NPI:1558334615
Name:JOLANTA A HERRERA MD PLLC
Entity Type:Organization
Organization Name:JOLANTA A HERRERA MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SANTIAGO
Authorized Official - Middle Name:E
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-526-7990
Mailing Address - Street 1:3236A BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-1456
Mailing Address - Country:US
Mailing Address - Phone:804-526-7990
Mailing Address - Fax:804-526-7905
Practice Address - Street 1:3236A BOULEVARD
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-1456
Practice Address - Country:US
Practice Address - Phone:804-526-7990
Practice Address - Fax:804-526-7905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-09
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101230277207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09379Medicare PIN