Basic Information
| Provider Information | |||||||||
| NPI: | 1245292614 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERRERA | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | ANTONIO | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1771 CALLE ANDROMEDA | ||||||||
| Address2: | URB VENUS GARDENS | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009264922 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877481749 | ||||||||
| FaxNumber: | 7877773702 | ||||||||
| Practice Location | |||||||||
| Address1: | BO. MONACILLOS CARR. 22 | ||||||||
| Address2: | PASEO DR. CELSO BARBOSA | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009350001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877773535 | ||||||||
| FaxNumber: | 7877773702 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 15966 | PR | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.