Healthcare Provider Details

I. General information

NPI: 1598117343
Provider Name (Legal Business Name): KIRSTEN HERRERA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2016
Last Update Date: 10/28/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6465 S SHORE BLVD
LEAGUE CITY TX
77573-5527
US

IV. Provider business mailing address

6465 S SHORE BLVD
LEAGUE CITY TX
77573-5527
US

V. Phone/Fax

Practice location:
  • Phone: 281-538-7735
  • Fax:
Mailing address:
  • Phone: 281-538-7735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberBP10057231
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberS3821
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: