Provider Demographics
NPI:1770840449
Name:GLORIA RIVERA HERRERA MD PA
Entity Type:Organization
Organization Name:GLORIA RIVERA HERRERA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:RIVERA
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-224-6161
Mailing Address - Street 1:PO BOX 461086
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78246-1086
Mailing Address - Country:US
Mailing Address - Phone:210-224-6161
Mailing Address - Fax:210-224-7231
Practice Address - Street 1:311 CAMDEN ST
Practice Address - Street 2:SUITE 403
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-2012
Practice Address - Country:US
Practice Address - Phone:210-224-6161
Practice Address - Fax:210-224-7231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX032798301Medicaid
TXA14202Medicare UPIN
TX032798301Medicaid