Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 20A6617 | CA |
NPI | 1104910744 |
---|---|
Provider Name | Michael A Herrera |
First Address | Stockton, CA 95219-2370 |
Second Address | Stockton, CA 95204-0000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20A6617 | OSTEOPATHIC CA LICENSE (01) | CA |
G06004 | (02) | CA |