Provider Demographics
NPI:1558894014
Name:RODOLFO A HERRERA MD/PA GROUP
Entity Type:Organization
Organization Name:RODOLFO A HERRERA MD/PA GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:VASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:COO
Authorized Official - Phone:214-780-6434
Mailing Address - Street 1:1305 AIRPORT FWY STE 302
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-6604
Mailing Address - Country:US
Mailing Address - Phone:817-283-6995
Mailing Address - Fax:
Practice Address - Street 1:1305 AIRPORT FWY STE 302
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-6604
Practice Address - Country:US
Practice Address - Phone:817-283-6995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty