Provider Demographics
NPI:1851303747
Name:HERRERA, ALEX C (PAC)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:C
Last Name:HERRERA
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:C
Other - Last Name:HERRERA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PAC
Mailing Address - Street 1:30382 N DOME DR
Mailing Address - Street 2:
Mailing Address - City:COARSEGOLD
Mailing Address - State:CA
Mailing Address - Zip Code:93614-9799
Mailing Address - Country:US
Mailing Address - Phone:559-658-5527
Mailing Address - Fax:
Practice Address - Street 1:16835 ALKALI DR
Practice Address - Street 2:SUITE M
Practice Address - City:LEMOORE
Practice Address - State:CA
Practice Address - Zip Code:93245-9463
Practice Address - Country:US
Practice Address - Phone:559-924-1541
Practice Address - Fax:559-924-2197
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13723363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P54995Medicare UPIN