Provider Demographics
NPI:1962686972
Name:HERRERA, ROBERTO JOSE (CRTT)
Entity Type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:JOSE
Last Name:HERRERA
Suffix:
Gender:M
Credentials:CRTT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 CRISTINA LEE LANE
Mailing Address - Street 2:
Mailing Address - City:ST.CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769
Mailing Address - Country:US
Mailing Address - Phone:321-652-3527
Mailing Address - Fax:
Practice Address - Street 1:1705 CRISTINA LEE LANE
Practice Address - Street 2:
Practice Address - City:ST.CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769
Practice Address - Country:US
Practice Address - Phone:321-652-3527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTT4829227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified