Provider Demographics
NPI:1386722502
Name:HERRO, MARK FREDERICK (LAC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:FREDERICK
Last Name:HERRO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 PACO MEDIANO
Mailing Address - Street 2:
Mailing Address - City:CARMEL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93924
Mailing Address - Country:US
Mailing Address - Phone:831-331-6110
Mailing Address - Fax:831-659-7569
Practice Address - Street 1:6 DEL FINO PLACE
Practice Address - Street 2:
Practice Address - City:CARMEL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93924
Practice Address - Country:US
Practice Address - Phone:831-659-5180
Practice Address - Fax:831-659-7569
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10890171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist