Provider Demographics
NPI:1356420053
Name:HERRERA, JOSE F (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:F
Last Name:HERRERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1135 S SUNSET AVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3937
Mailing Address - Country:US
Mailing Address - Phone:626-337-1800
Mailing Address - Fax:626-337-1449
Practice Address - Street 1:1135 S SUNSET AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3937
Practice Address - Country:US
Practice Address - Phone:626-337-1800
Practice Address - Fax:626-337-1449
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA066516207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000A066516Medicaid
CA000A066516Medicaid
W15228Medicare ID - Type Unspecified