Provider Demographics
NPI:1013906965
Name:HERRADA, ALBERTO (DPM)
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:
Last Name:HERRADA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10600 GRIFFIN RD
Mailing Address - Street 2:SUITE 107A
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3208
Mailing Address - Country:US
Mailing Address - Phone:954-434-9877
Mailing Address - Fax:954-434-9881
Practice Address - Street 1:10600 GRIFFIN RD
Practice Address - Street 2:SUITE 107
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-3208
Practice Address - Country:US
Practice Address - Phone:954-434-9877
Practice Address - Fax:954-434-9881
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPO02861213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340154500Medicaid
FLU81290Medicare UPIN
FLE4393ZMedicare PIN