Healthcare Provider Details

I. General information

NPI: 1467767897
Provider Name (Legal Business Name): HERDZ INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2010
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4007 RIO YAQUI
CD.JUAREZ CHIH.
32310
MX

IV. Provider business mailing address

12222 ROBERTA LYNNE DR
EL PASO TX
79936-6809
US

V. Phone/Fax

Practice location:
  • Phone: 656-616-4464
  • Fax:
Mailing address:
  • Phone: 915-590-2524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number3589415
License Number StateZZ
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number4132190
License Number StateZZ
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number3356666
License Number StateZZ
# 4
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number3023198
License Number StateZZ
# 5
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4991336
License Number StateZZ

VIII. Authorized Official

Name: MRS. LYDIA HERNANDEZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 915-590-2524