Provider Demographics
NPI:1952627473
Name:HERRERA, MARIA MILDRED (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:MILDRED
Last Name:HERRERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 16TH ST
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-5154
Mailing Address - Country:US
Mailing Address - Phone:970-810-2026
Mailing Address - Fax:970-810-2028
Practice Address - Street 1:1750 E KEN PRATT BLVD FL 3
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504-5311
Practice Address - Country:US
Practice Address - Phone:970-810-2026
Practice Address - Fax:970-810-2028
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0056839207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11185058Medicaid