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General NPI Number Information
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NPI Number | 1417366303
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Entity Type | Individual
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Provider Name | MAURICIO A HERRADOR
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Gender | Male
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Dates
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Enumeration Date | 08/05/2014
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Last Update Date | 08/14/2019
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Provider Practice Location Address
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Address Line | 1401 EMERSON RD
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City | ELLENSBURG
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State | WA
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Zip | 98926-8437
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Country | US
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Telephone | 509-431-8035
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Fax |
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Provider Business Mailing Address
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Address Line | 116 GRANDVIEW ST
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City | SANTA CRUZ
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State | CA
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Zip | 95060-3015
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Country | US
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Telephone | 509-431-8035
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | P1 60044952
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License Number State | WA
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