Provider Demographics
NPI:1124439484
Name:HERRERO, EDWIN
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:HERRERO
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 1:830 N DIAMOND BAR BLVD.
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-1039
Mailing Address - Country:US
Mailing Address - Phone:714-590-0100
Mailing Address - Fax:714-590-0089
Practice Address - Street 1:830 N DIAMOND BAR BLVD.
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-1039
Practice Address - Country:US
Practice Address - Phone:714-590-0100
Practice Address - Fax:714-590-0089
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-08
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 37674225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist