Healthcare Provider Details

I. General information

NPI: 1780869859
Provider Name (Legal Business Name): J MANUEL HERRERA MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1261 N WILMOT RD
TUCSON AZ
85712-5154
US

IV. Provider business mailing address

1261 N WILMOT RD
TUCSON AZ
85712
US

V. Phone/Fax

Practice location:
  • Phone: 520-722-6858
  • Fax:
Mailing address:
  • Phone: 520-722-6858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number14965
License Number StateAZ

VIII. Authorized Official

Name: DINA FIMBRES
Title or Position: OFFICE MANAGER
Credential:
Phone: 520-733-1448