MEDICARE: SUSANA HERRERA OVALLE M.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
1	207Q00000X	Family Medicine Physician	A97626	CA

General Provider Information

NPI Number	:	1437375268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSANA HERRERA OVALLE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 35380
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-5380
Country	:	US
Telephone Number	:	702-579-3203
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 SEPULVEDA BLVD
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90501-5301
Country	:	US
Telephone Number	:	310-326-9167
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	02/17/2026

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