Provider Demographics
NPI:1821461948
Name:HERRERA, DIANA (DOM)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:HERRERA
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2538 CAMINO ENTRADA STE 300
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-4927
Mailing Address - Country:US
Mailing Address - Phone:505-424-1239
Mailing Address - Fax:888-746-4761
Practice Address - Street 1:2538 CAMINO ENTRADA STE 300
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4927
Practice Address - Country:US
Practice Address - Phone:505-424-1239
Practice Address - Fax:888-746-4761
Is Sole Proprietor?:No
Enumeration Date:2015-11-11
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM171100000X171100000X
NM260708446171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist