MEDICARE: VICTOR L. HERRERA, D.P.M., P.A

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
1	261QA1903X	Ambulatory Surgical Clinic/Center	PO3517	FL
2	261QR0200X	Radiology Clinic/Center	PO3517	FL
3	261QM2500X	Medical Specialty Clinic/Center	PO3517	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275892309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICTOR L. HERRERA, D.P.M., P.A

Provider Business Mailing Address
First Line	:	4980 PALM AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3726
Country	:	US
Telephone Number	:	305-512-0080
Fax Number	:	305-512-0082

Provider Business Practice Location Address
First Line	:	4980 PALM AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3726
Country	:	US
Telephone Number	:	305-512-0080
Fax Number	:	305-512-0082

Authorized Official
Title or Position	:	OWNER
Name	:	VICTOR HERRERA
Credential	:
Telephone Number	:	305-773-5096

Provider Enumeration Date	:	05/09/2012
Last Update Date	:	05/09/2012

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Directions to “VICTOR L. HERRERA, D.P.M., P.A ” Practice Location

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