Provider Demographics
NPI:1689716714
Name:HERRERA, MARIA CLARISSA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:CLARISSA
Last Name:HERRERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5327 N CENTRAL EXPY STE 300
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-3380
Mailing Address - Country:US
Mailing Address - Phone:214-219-5880
Mailing Address - Fax:214-219-5881
Practice Address - Street 1:5327 N CENTRAL EXPY STE 300
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-3380
Practice Address - Country:US
Practice Address - Phone:214-219-5880
Practice Address - Fax:214-219-5881
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD431628207ZP0102X, 207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX195632801Medicaid
PA50069653OtherCAPITAL BLUE CROSS
TX8BL180OtherBCBSTX
TX195632802Medicaid
TX195632802Medicaid
TX195632801Medicaid