Healthcare Provider Details

I. General information

NPI: 1144295890
Provider Name (Legal Business Name): SANDRA HERRON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S HOUGHTON RD STE 101
TUCSON AZ
85748-6732
US

IV. Provider business mailing address

105 S HOUGHTON RD STE 101
TUCSON AZ
85748-6732
US

V. Phone/Fax

Practice location:
  • Phone: 520-345-3645
  • Fax:
Mailing address:
  • Phone: 520-438-5449
  • Fax: 520-547-5692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number28709
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: