Provider Demographics
NPI:1730370313
Name:HERRERA, EMMA DANIELA (IDC)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:DANIELA
Last Name:HERRERA
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 AYRES CIRCLE
Mailing Address - Street 2:BLDG H-1
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03804-5000
Mailing Address - Country:US
Mailing Address - Phone:207-438-4940
Mailing Address - Fax:207-438-3838
Practice Address - Street 1:1 AYRES CIRCLE
Practice Address - Street 2:BLDG H-1
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03804-5000
Practice Address - Country:US
Practice Address - Phone:207-438-4940
Practice Address - Fax:207-438-3838
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman