Healthcare Provider Details

I. General information

NPI: 1619930195
Provider Name (Legal Business Name): LUIS HERRERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 W UNDERWOOD ST
ORLANDO FL
32806-1110
US

IV. Provider business mailing address

22 W UNDERWOOD ST
ORLANDO FL
32806-1110
US

V. Phone/Fax

Practice location:
  • Phone: 407-648-3800
  • Fax: 407-872-7754
Mailing address:
  • Phone: 407-648-3800
  • Fax: 407-872-7754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberME94521
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: