Healthcare Provider Details

I. General information

NPI: 1982932109
Provider Name (Legal Business Name): RAYMOND HERRERA BA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2009
Last Update Date: 11/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 FORUM PL BLDG 400 D & E
WEST PALM BEACH FL
33401-2319
US

IV. Provider business mailing address

12984 63RD LN N
WEST PALM BEACH FL
33412-2034
US

V. Phone/Fax

Practice location:
  • Phone: 561-616-8411
  • Fax: 561-616-8412
Mailing address:
  • Phone: 561-252-4475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: