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NPI Code Detail

MEDICARE: RAUL ALEJANDRO HERRERA IZQUIERDO SR. MSN, RN, FNP-C

MEDICARE: RAUL ALEJANDRO HERRERA IZQUIERDO SR. MSN, RN, FNP-C
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
1163W00000XRegistered Nurse893776NY
2363LF0000XFamily Nurse Practitioner357751NY

General Provider Information

NPI Number : 1255114039
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAUL ALEJANDRO HERRERA IZQUIERDO SR. MSN, RN, FNP-C
Provider Business Mailing Address
First Line : 1262 BOSTON RD STE 2
Second Line :
City : BRONX
State : NY
Zip : 10456-3541
Country : US
Telephone Number : 929-606-0054
Fax Number :
Provider Business Practice Location Address
First Line : 1262 BOSTON RD STE 2
Second Line :
City : BRONX
State : NY
Zip : 10456-3541
Country : US
Telephone Number : 718-569-7929
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2023
Last Update Date : 09/06/2025

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