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General NPI Number Information
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NPI Number | 1043424559
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Entity Type | Organization
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Legal Business Name | JORGE A HERRERA PHD PA
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1378 CORAL WAY SUITE 500
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City | MIAMI
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State | FL
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Zip | 33145-2943
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Country | US
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Telephone | 305-445-3222
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Fax | 305-529-8510
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Provider Business Mailing Address
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Address Line | PO BOX 142064
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City | CORAL GABLES
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State | FL
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Zip | 33114-2064
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Country | US
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Telephone | 786-314-5644
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Fax | 786-314-5677
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Authorized Official
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Title or Position | DIRECTOR
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Name | JORGE A HERRERA
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Credential | PH.D.
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Telephone | 305-445-3222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | PY3733
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License Number State | FL
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