Basic Information
| Provider Information | |||||||||
| NPI: | 1588628671 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERRERA | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6037 KIMBERLY BLVD | ||||||||
| Address2: | |||||||||
| City: | NORTH LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330682811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543798994 | ||||||||
| FaxNumber: | 9549772711 | ||||||||
| Practice Location | |||||||||
| Address1: | 6037 KIMBERLY BLVD | ||||||||
| Address2: | |||||||||
| City: | NORTH LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330682811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543798994 | ||||||||
| FaxNumber: | 9549772711 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 12/07/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | ME0054912 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
No ID Information.