Doctor Name: | DR. CARLOS JAIME HERRERA |
NPI Number: | 1194069989 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 1735074 |
Business Practice Address: | 1471 Avenida Revolucion, Entre 7 Y 8 Tijuana, BAJA CALIFORNIA - 22000 |
Business Phone Number: | 526646855004 |
Business Fax Number: | |
Mailing Address: | Po Box 13824, SAN DIEGO |
State: | CA |
Postal Code: | 921703824 |
Phone Number: | 6196160700 |
Fax Number: | |
NPI Enumeration Date: | 11/16/2012 |
NPI Last Update Date: | 11/16/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 1735074 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ZZ |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |