Provider Demographics
NPI:1104567080
Name:HERRERA, BRIAN GIOVANNI
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:GIOVANNI
Last Name:HERRERA
Suffix:
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 1:8394 SW 154TH AVE APT 44
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-1271
Mailing Address - Country:US
Mailing Address - Phone:786-343-3821
Mailing Address - Fax:
Practice Address - Street 1:8394 SW 154TH AVE APT 44
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-1271
Practice Address - Country:US
Practice Address - Phone:786-343-3821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician