Provider Demographics
NPI:1295812774
Name:HERRERA-TAN, HERMINIA GUMABAY (MD)
Entity type:Individual
Prefix:DR
First Name:HERMINIA
Middle Name:GUMABAY
Last Name:HERRERA-TAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:HERMINIA
Other - Middle Name:GUMABAY
Other - Last Name:HERRERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9515 W CAMELBACK RD STE 136
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-1364
Mailing Address - Country:US
Mailing Address - Phone:623-322-8906
Mailing Address - Fax:623-322-8430
Practice Address - Street 1:9515 W CAMELBACK RD STE 136
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-1364
Practice Address - Country:US
Practice Address - Phone:623-322-8906
Practice Address - Fax:623-322-8430
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29828207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine