Provider Demographics
NPI:1013493972
Name:HERRERA, LUDIM E
Entity Type:Individual
Prefix:
First Name:LUDIM
Middle Name:E
Last Name:HERRERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3152 SW 17TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-1802
Mailing Address - Country:US
Mailing Address - Phone:786-378-0358
Mailing Address - Fax:
Practice Address - Street 1:2103 CORAL WAY STE 603
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2656
Practice Address - Country:US
Practice Address - Phone:786-464-0353
Practice Address - Fax:786-483-8142
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-13
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
FL9268132363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily