Healthcare Provider Details

I. General information

NPI: 1093329179
Provider Name (Legal Business Name): DHARMA DILIA HERRERA VASQUEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DHARMA HERRERA-CALLAN MD

II. Dates (important events)

Enumeration Date: 09/04/2020
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10211 ROOSEVELT AVE
CORONA NY
11368-2331
US

IV. Provider business mailing address

10211 ROOSEVELT AVE
CORONA NY
11368-2331
US

V. Phone/Fax

Practice location:
  • Phone: 718-898-5200
  • Fax:
Mailing address:
  • Phone: 718-898-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number325775
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number325775
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: