Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 53705 | CA |
NPI | 1124239488 |
---|---|
Provider Name | Mr. Andres F Herrera |
First Address | Salinas, CA 93901-4357 |
Second Address | Salinas, CA 93901-4000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2007 |
Last Update Date | 23/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G89919-01 | DENTICAL (01) | CA |