Healthcare Provider Details

I. General information

NPI: 1073239158
Provider Name (Legal Business Name): TOMAIIS HERRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2022
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3534 ANDERSON AVE SE
ALBUQUERQUE NM
87106-1612
US

IV. Provider business mailing address

3534 ANDERSON AVE SE
ALBUQUERQUE NM
87106-1612
US

V. Phone/Fax

Practice location:
  • Phone: 505-573-8924
  • Fax:
Mailing address:
  • Phone: 505-573-8924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: