Basic Information
| Provider Information | |||||||||
| NPI: | 1932567567 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERRERA GONZALEZ | ||||||||
| FirstName: | ONEDO | ||||||||
| MiddleName: | RICARDO | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 950 SW 57TH AVE APT 539 | ||||||||
| Address2: | |||||||||
| City: | WEST MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331445092 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7866609377 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3448 NW 79TH ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331474602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8552266633 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2016 | ||||||||
| LastUpdateDate: | 03/10/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 19252 | PR | N | Allopathic & Osteopathic Physicians | General Practice | 208D00000X | ACN950 | FL | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.