Provider Demographics
NPI:1861110587
Name:HERRERA, RUBY GOMEZ
Entity type:Individual
Prefix:
First Name:RUBY
Middle Name:GOMEZ
Last Name:HERRERA
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 1:5895 SAN FELIPE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-3061
Mailing Address - Country:US
Mailing Address - Phone:713-278-8474
Mailing Address - Fax:
Practice Address - Street 1:5895 SAN FELIPE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-3061
Practice Address - Country:US
Practice Address - Phone:713-278-8474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX316181183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician