Provider Demographics
NPI:1336776178
Name:HERRERA, CARLOS ROBERTO (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ROBERTO
Last Name:HERRERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 BENEDICT AVE APT 4D
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-4427
Mailing Address - Country:US
Mailing Address - Phone:347-589-7173
Mailing Address - Fax:
Practice Address - Street 1:127 S BROADWAY
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-4006
Practice Address - Country:US
Practice Address - Phone:914-378-7586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY324390207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine