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General NPI Number Information
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NPI Number | 1275892309
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Entity Type | Organization
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Legal Business Name | VICTOR L. HERRERA, D.P.M., P.A
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Dates
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Enumeration Date | 05/09/2012
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Last Update Date | 05/09/2012
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Provider Practice Location Address
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Address Line | 4980 PALM AVE
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City | HIALEAH
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State | FL
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Zip | 33012-3726
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Country | US
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Telephone | 305-512-0080
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Fax | 305-512-0082
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Provider Business Mailing Address
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Address Line | 4980 PALM AVE
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City | HIALEAH
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State | FL
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Zip | 33012-3726
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Country | US
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Telephone | 305-512-0080
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Fax | 305-512-0082
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Authorized Official
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Title or Position | OWNER
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Name | VICTOR HERRERA
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Credential |
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Telephone | 305-773-5096
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | PO3517
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | PO3517
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | PO3517
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License Number State | FL
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