Provider Demographics
NPI:1740243971
Name:HERRERA, CHRISTIAN YANEZ (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:YANEZ
Last Name:HERRERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3824 N LITTLE ROCK LANE
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-5234
Mailing Address - Country:US
Mailing Address - Phone:801-226-1066
Mailing Address - Fax:801-226-8448
Practice Address - Street 1:3824 N LITTLE ROCK LANE
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-5234
Practice Address - Country:US
Practice Address - Phone:801-226-1066
Practice Address - Fax:801-226-8448
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1646601205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G44437Medicare UPIN