MEDICARE: KIMBERLY HERRERA

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
1	174400000X	Specialist
2	124Q00000X	Dental Hygienist	906357	CO

General Provider Information

NPI Number	:	1295329233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY HERRERA

Provider Business Mailing Address
First Line	:	5268 SNOW GOOSE ST
Second Line	:
City	:	BRIGHTON
State	:	CO
Zip	:	80601-5344
Country	:	US
Telephone Number	:	720-339-8671
Fax Number	:

Provider Business Practice Location Address
First Line	:	5268 SNOW GOOSE ST
Second Line	:
City	:	BRIGHTON
State	:	CO
Zip	:	80601-5344
Country	:	US
Telephone Number	:	720-339-8671
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2021
Last Update Date	:	02/20/2021

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Directions to “ KIMBERLY HERRERA ” Practice Location

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