Provider Demographics
NPI:1154521391
Name:HERRERA, LUIS ALI
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ALI
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 1:141 N PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1904
Mailing Address - Country:US
Mailing Address - Phone:310-330-0080
Mailing Address - Fax:310-330-3995
Practice Address - Street 1:141 N PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1904
Practice Address - Country:US
Practice Address - Phone:310-330-0080
Practice Address - Fax:310-330-3995
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA532221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice