Provider Demographics
NPI:1649608522
Name:HERRERA, FERNANDO MIGUEL
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:MIGUEL
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 1:2070 SWEETBROOM CIR APT 307
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559-8727
Mailing Address - Country:US
Mailing Address - Phone:727-457-6208
Mailing Address - Fax:
Practice Address - Street 1:2070 SWEETBROOM CIR APT 307
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559-8727
Practice Address - Country:US
Practice Address - Phone:727-457-6208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-31
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst