Healthcare Provider Details

I. General information

NPI: 1255750881
Provider Name (Legal Business Name): RAUL HERRERA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2014
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 PALM BEACH LAKES BLVD STE 300
WEST PALM BEACH FL
33401-2203
US

IV. Provider business mailing address

1655 PALM BEACH LAKES BLVD STE 300 300
WEST PALM BEACH FL
33401-2203
US

V. Phone/Fax

Practice location:
  • Phone: 561-612-6049
  • Fax: 561-612-6049
Mailing address:
  • Phone: 561-612-6049
  • Fax: 561-612-6049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCBHCMS.0100495
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: