Healthcare Provider Details

I. General information

NPI: 1417422262
Provider Name (Legal Business Name): ALEJANDRA HERRERA MUNOZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2018
Last Update Date: 10/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

646 103RD AVE N
NAPLES FL
34108
US

IV. Provider business mailing address

646 103RD AVE N
NAPLES FL
34108-3219
US

V. Phone/Fax

Practice location:
  • Phone: 239-293-8288
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOTA14762
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: