Healthcare Provider Details

I. General information

NPI: 1275892309
Provider Name (Legal Business Name): VICTOR L. HERRERA, D.P.M., P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2012
Last Update Date: 05/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4980 PALM AVE
HIALEAH FL
33012-3726
US

IV. Provider business mailing address

4980 PALM AVE
HIALEAH FL
33012-3726
US

V. Phone/Fax

Practice location:
  • Phone: 305-512-0080
  • Fax: 305-512-0082
Mailing address:
  • Phone: 305-512-0080
  • Fax: 305-512-0082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberPO3517
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberPO3517
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberPO3517
License Number StateFL

VIII. Authorized Official

Name: VICTOR HERRERA
Title or Position: OWNER
Credential:
Phone: 305-773-5096