Healthcare Provider Details

I. General information

NPI: 1255114039
Provider Name (Legal Business Name): RAUL ALEJANDRO HERRERA IZQUIERDO SR. , FNP-BC, CMGT-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2023
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1262 BOSTON RD STE 2
BRONX NY
10456-3541
US

IV. Provider business mailing address

1262 BOSTON RD STE 2
BRONX NY
10456-3541
US

V. Phone/Fax

Practice location:
  • Phone: 718-569-7929
  • Fax:
Mailing address:
  • Phone: 929-606-0054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number893776
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number893776
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number357751
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: