Provider Demographics
NPI:1851767065
Name:HERRERA, BRUNO S (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRUNO
Middle Name:S
Last Name:HERRERA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7828 DAY CREEK BLVD APT 2-225
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-8569
Mailing Address - Country:US
Mailing Address - Phone:919-265-8040
Mailing Address - Fax:
Practice Address - Street 1:71817 HIGHWAY 111 STE 1
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4487
Practice Address - Country:US
Practice Address - Phone:760-340-5155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC151064122300000X
MO2021021861223P0300X
CA1056761223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist