Healthcare Provider Details

I. General information

NPI: 1003148651
Provider Name (Legal Business Name): VICTORIA HERRERA B.A. (DUAL)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2010
Last Update Date: 10/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4312 CARLISLE BLVD NE
ALBUQUERQUE NM
87107-4811
US

IV. Provider business mailing address

4312 CARLISLE BLVD NE
ALBUQUERQUE NM
87107-4811
US

V. Phone/Fax

Practice location:
  • Phone: 505-323-3785
  • Fax: 505-323-3850
Mailing address:
  • Phone: 505-323-3785
  • Fax: 505-323-3850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: