Provider Demographics
NPI:1255385332
Name:HERRERA, AGUEDA ISABEL (MD)
Entity type:Individual
Prefix:DR
First Name:AGUEDA
Middle Name:ISABEL
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:A4 CALLE 2
Mailing Address - Street 2:URB. LAS MERCEDES
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-3305
Mailing Address - Country:US
Mailing Address - Phone:787-733-8679
Mailing Address - Fax:
Practice Address - Street 1:ST TWENTY TWO BO MONACILLOS PASEO DR CELSO BARBOSA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00935-0001
Practice Address - Country:US
Practice Address - Phone:787-777-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8821208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR8-1679Medicare ID - Type UnspecifiedPART B