Healthcare Provider Details

I. General information

NPI: 1114374063
Provider Name (Legal Business Name): MARIA CHRISTINA HERRERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2016
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5520 PARK AVE
TRUMBULL CT
06611-3463
US

IV. Provider business mailing address

100 CHURCH ST S STE A222
NEW HAVEN CT
06519-1703
US

V. Phone/Fax

Practice location:
  • Phone: 845-494-2259
  • Fax:
Mailing address:
  • Phone: 845-494-2259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number79541
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number79541
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: