1699368522 NPI number — MICHAEL ANDREW HERRE ANDREW HERRERA RBT

Table of content: MICHAEL ANDREW HERRE ANDREW HERRERA RBT (NPI 1699368522)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699368522 NPI number — MICHAEL ANDREW HERRE ANDREW HERRERA RBT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERRERA
Provider First Name:
MICHAEL ANDREW HERRE
Provider Middle Name:
ANDREW
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RBT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1699368522
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
586 MAROON LAKE CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DIVIDE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80814-9709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
151-586-5250
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
265 S HARLAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80226-2261
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-272-1289
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/11/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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