Provider Demographics
NPI:1740257781
Name:HERRERA ABUHAZI, IDAMYS ANGELICA (MD)
Entity type:Individual
Prefix:DR
First Name:IDAMYS
Middle Name:ANGELICA
Last Name:HERRERA ABUHAZI
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 1:1433 CALLE SAN ENRIQUE
Mailing Address - Street 2:ALTAMESA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-3709
Mailing Address - Country:US
Mailing Address - Phone:787-505-1848
Mailing Address - Fax:
Practice Address - Street 1:1433 CALLE SAN ENRIQUE
Practice Address - Street 2:ALTAMESA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3709
Practice Address - Country:US
Practice Address - Phone:787-505-1848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16115208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice