Provider Demographics
NPI:1689422461
Name:HERRERA DE LEON, MARILENNY
Entity type:Individual
Prefix:
First Name:MARILENNY
Middle Name:
Last Name:HERRERA DE LEON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-1922
Mailing Address - Country:US
Mailing Address - Phone:347-636-7507
Mailing Address - Fax:
Practice Address - Street 1:264 HIGHLAND BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-1922
Practice Address - Country:US
Practice Address - Phone:347-636-7507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program