Provider Demographics
NPI:1558542365
Name:HERRERA, GLORIA VALDEZ
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:VALDEZ
Last Name:HERRERA
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:GLORIA
Other - Middle Name:VALDEZ
Other - Last Name:RAMOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3766 N PARK DR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-2126
Mailing Address - Country:US
Mailing Address - Phone:928-266-0284
Mailing Address - Fax:
Practice Address - Street 1:3766 N PARK DR
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-2126
Practice Address - Country:US
Practice Address - Phone:928-266-0284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2736173747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant