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NPI Code Detail

MEDICARE: DR. NIDFEL NERETVA HERRERA NMD, PA-C

MEDICARE: DR. NIDFEL NERETVA HERRERA NMD, PA-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
1363A00000XPhysician Assistant19541CA

General Provider Information

NPI Number : 1295993442
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NIDFEL NERETVA HERRERA NMD, PA-C
Provider Business Mailing Address
First Line : 5767 W CENTURY BLVD STE 400
Second Line :
City : LOS ANGELES
State : CA
Zip : 90045-5631
Country : US
Telephone Number : 310-301-8707
Fax Number :
Provider Business Practice Location Address
First Line : 27235 TOURNEY RD STE 2500
Second Line :
City : VALENCIA
State : CA
Zip : 91355-5908
Country : US
Telephone Number : 661-253-5851
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2008
Last Update Date : 02/01/2024

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