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General NPI Number Information
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NPI Number | 1467864991
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Entity Type | Organization
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Legal Business Name | LUZ A. HERRERA PHYSICIAN ASSISTANT INC
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Dates
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Enumeration Date | 06/02/2014
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Last Update Date | 06/02/2014
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Provider Practice Location Address
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Address Line | 3855 W 105TH ST
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City | INGLEWOOD
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State | CA
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Zip | 90303-1812
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Country | US
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Telephone | 310-922-1096
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Fax |
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Provider Business Mailing Address
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Address Line | 3855 W 105TH ST
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City | INGLEWOOD
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State | CA
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Zip | 90303-1812
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Country | US
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Telephone | 310-922-1096
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | LUZ A HERRERA
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Credential | PA-C
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Telephone | 310-922-1096
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | PA22843
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License Number State | CA
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