Provider Demographics
NPI:1639895147
Name:HERRERA, RUBI
Entity Type:Individual
Prefix:
First Name:RUBI
Middle Name:
Last Name:HERRERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6339 SHADOW CREEK DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-7804
Mailing Address - Country:US
Mailing Address - Phone:704-804-1045
Mailing Address - Fax:
Practice Address - Street 1:6339 SHADOW CREEK DR
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-7804
Practice Address - Country:US
Practice Address - Phone:704-804-1045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker