Provider Demographics
NPI:1902909443
Name:HERRERA, GLORIA RIVERA (MD)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:RIVERA
Last Name:HERRERA
Suffix:
Gender:F
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:PO BOX 461086
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78246-1086
Mailing Address - Country:US
Mailing Address - Phone:210-224-6161
Mailing Address - Fax:210-224-7231
Practice Address - Street 1:311 CAMDEN ST
Practice Address - Street 2:STE 403
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-2012
Practice Address - Country:US
Practice Address - Phone:210-224-6161
Practice Address - Fax:210-224-7231
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6740207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX032798301Medicaid
TX032798301Medicaid
TXA14202Medicare UPIN