Provider Demographics
NPI:1952528002
Name:HERRERA, GASTON CAGIGAO (MD)
Entity Type:Individual
Prefix:DR
First Name:GASTON
Middle Name:CAGIGAO
Last Name:HERRERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 E. VERNON AVE SUITE# F
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90011
Mailing Address - Country:US
Mailing Address - Phone:323-233-9686
Mailing Address - Fax:323-233-0595
Practice Address - Street 1:1061 E. VERNON AVE SUITE# F
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011
Practice Address - Country:US
Practice Address - Phone:323-233-9686
Practice Address - Fax:323-233-0595
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA23808207R00000X, 207V00000X, 208000000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11568785OtherCAQH
CAA23808Medicaid
CAA23808LOtherHEALTHY FAMILY
CAA23808MMOtherMEDICARE SPECIAL NEEDS PROGRAM
CA3034086236OtherHEALTH NET
CAA23808SOtherHEALTHY KIDS
CACARE 1STOtherA23808F4
CAA23808ZOtherLA CARE
CAE98354Medicare UPIN
CACARE 1STOtherA23808F4