Healthcare Provider Details

I. General information

NPI: 1295910156
Provider Name (Legal Business Name): JOSE NOE HERRERA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2008
Last Update Date: 06/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5415 S MCCOLL RD
EDINBURG TX
78539-9183
US

IV. Provider business mailing address

5501 S MCCOLL RD
EDINBURG TX
78539-9152
US

V. Phone/Fax

Practice location:
  • Phone: 956-661-0529
  • Fax: 956-618-4639
Mailing address:
  • Phone: 956-661-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number616338
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number616338
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: