Provider Demographics
NPI:1316831639
Name:HERRERA, PEDRO III
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:
Last Name:HERRERA
Suffix:III
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 1:114 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-4153
Mailing Address - Country:US
Mailing Address - Phone:830-309-6568
Mailing Address - Fax:
Practice Address - Street 1:114 RIDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-4153
Practice Address - Country:US
Practice Address - Phone:830-309-6568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXCPED4723224L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist