Healthcare Provider Details

I. General information

NPI: 1669960415
Provider Name (Legal Business Name): DAISY HERRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2018
Last Update Date: 04/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 W SEMANDS ST
CONROE TX
77301-1867
US

IV. Provider business mailing address

2719 3RD ST TRLR 60
HUFFMAN TX
77336-2434
US

V. Phone/Fax

Practice location:
  • Phone: 936-756-5598
  • Fax: 936-756-5974
Mailing address:
  • Phone: 281-622-1321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number336914
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: