Healthcare Provider Details

I. General information

NPI: 1962686972
Provider Name (Legal Business Name): ROBERTO JOSE HERRERA CRTT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 CRISTINA LEE LANE
ST.CLOUD FL
34769
US

IV. Provider business mailing address

1705 CRISTINA LEE LANE
ST.CLOUD FL
34769
US

V. Phone/Fax

Practice location:
  • Phone: 321-652-3527
  • Fax:
Mailing address:
  • Phone: 321-652-3527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberTT4829
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: