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NPI Code Detail

MEDICARE: ALEXANDRA HERRERA LMSW

MEDICARE: ALEXANDRA HERRERA LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerM-09637NM

General Provider Information

NPI Number : 1174073100
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXANDRA HERRERA LMSW
Provider Business Mailing Address
First Line : PO BOX 335
Second Line :
City : LAS VEGAS
State : NM
Zip : 87701-0335
Country : US
Telephone Number : 505-429-0198
Fax Number :
Provider Business Practice Location Address
First Line : 2528 RIDGE RUNNER RD
Second Line :
City : LAS VEGAS
State : NM
Zip : 87701-4971
Country : US
Telephone Number : 505-429-0198
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2016
Last Update Date : 10/13/2016

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