Provider Demographics
NPI:1598745507
Name:HERRERA, RAFAELA (MD)
Entity Type:Individual
Prefix:
First Name:RAFAELA
Middle Name:
Last Name:HERRERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RAFAELA
Other - Middle Name:
Other - Last Name:RODRIGUEZ-CAZARES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 504939
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-4939
Mailing Address - Country:US
Mailing Address - Phone:816-932-7940
Mailing Address - Fax:816-932-7957
Practice Address - Street 1:2121 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2126
Practice Address - Country:US
Practice Address - Phone:816-471-0900
Practice Address - Fax:816-471-3150
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3G65208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205787716Medicaid
D196941Medicare ID - Type Unspecified
MO205787716Medicaid