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General NPI Number Information
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NPI Number | 1639095144
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Entity Type | Individual
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Provider Name | LUIS HERRERA
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Gender | Male
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Dates
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Enumeration Date | 06/29/2026
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Last Update Date | 06/29/2026
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Provider Practice Location Address
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Address Line | 3939 N STOCKTON HILL RD STE A
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City | KINGMAN
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State | AZ
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Zip | 86409-3247
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Country | US
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Telephone | 954-439-6167
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Fax |
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Provider Business Mailing Address
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Address Line | 777 HARRAH WAY APT 107
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-0813
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Country | US
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Telephone | 954-439-6167
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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 | 2471R0002X
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Taxonomy Name | Radiation Therapy Radiologic Technologist
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License Number | CTT0000104046
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License Number State | AZ
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