Provider Demographics
NPI:1457731267
Name:HERRERA, SHAWN
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
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:PO BOX 454
Mailing Address - Street 2:
Mailing Address - City:LUQUILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00773-0454
Mailing Address - Country:US
Mailing Address - Phone:787-513-7685
Mailing Address - Fax:
Practice Address - Street 1:CC2 CALLE A
Practice Address - Street 2:CALLE 14 DE JULIO BUZON 454
Practice Address - City:LUQUILLO
Practice Address - State:PR
Practice Address - Zip Code:00773-2611
Practice Address - Country:US
Practice Address - Phone:787-513-7685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-06
Last Update Date:2015-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6116018172A00000X, 344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No344600000XTransportation ServicesTaxi