Provider Demographics
NPI:1053684274
Name:HERRERA, ANDRO F
Entity type:Individual
Prefix:
First Name:ANDRO
Middle Name:F
Last Name:HERRERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15411 SW 39TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5418
Mailing Address - Country:US
Mailing Address - Phone:305-753-3035
Mailing Address - Fax:305-485-3884
Practice Address - Street 1:15411 SW 39TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-5418
Practice Address - Country:US
Practice Address - Phone:305-753-3035
Practice Address - Fax:305-485-3884
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-18
Last Update Date:2012-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA66233225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist