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NPI Code Detail

MEDICARE: DR. MANUEL JESUS HERRERA LEGON PH.D.

MEDICARE: DR. MANUEL JESUS HERRERA LEGON PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistPY11689FL

General Provider Information

NPI Number : 1013625078
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MANUEL JESUS HERRERA LEGON PH.D.
Provider Business Mailing Address
First Line : 13800 VETERANS WAY
Second Line :
City : ORLANDO
State : FL
Zip : 32827-7401
Country : US
Telephone Number : 407-538-2268
Fax Number :
Provider Business Practice Location Address
First Line : 13800 VETERANS WAY
Second Line :
City : ORLANDO
State : FL
Zip : 32827-7401
Country : US
Telephone Number : 407-538-2268
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2022
Last Update Date : 04/23/2026

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