1508410846 NPI number — HERRERA MEDICAL GROUP PLLC

Table of content: (NPI 1508410846)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508410846 NPI number — HERRERA MEDICAL GROUP PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HERRERA MEDICAL GROUP PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
REGENERATIVE CARE INSTITUTE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508410846
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/12/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
571 W MAIN ST STE 120
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWISVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75057-3667
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-436-7531
Provider Business Mailing Address Fax Number:
972-436-6114

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1305 AIRPORT FWY STE 302
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEDFORD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76021-6604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-283-6995
Provider Business Practice Location Address Fax Number:
817-952-7011
Provider Enumeration Date:
07/25/2019

Additional Information

Authorized Official

Authorized Official Last Name:
HERRERA
Authorized Official First Name:
RODOLFO
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
972-436-7531

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QS0010X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0014X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com