MEDICARE: RUBI HERRERA

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	376J00000X	Homemaker

General Provider Information

NPI Number	:	1639895147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUBI HERRERA

Provider Business Mailing Address
First Line	:	6339 SHADOW CREEK DR
Second Line	:
City	:	MEDINA
State	:	OH
Zip	:	44256-7804
Country	:	US
Telephone Number	:	704-804-1045
Fax Number	:

Provider Business Practice Location Address
First Line	:	6339 SHADOW CREEK DR
Second Line	:
City	:	MEDINA
State	:	OH
Zip	:	44256-7804
Country	:	US
Telephone Number	:	704-804-1045
Fax Number	:

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

Provider Enumeration Date	:	10/17/2022
Last Update Date	:	10/17/2022

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Directions to “ RUBI HERRERA ” Practice Location

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