Provider Information for 1548420615
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Dr. JAIME IMITOLA HERRERA MD.
Sex: Male
NPI: 1548420615
Last Updated: 2022-09-26
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1548420615 | ||||||||||||||
| Enumeration Date | 2008-06-12 | ||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||
| Sole Proprietor | NO | ||||||||||||||
| Status | Active | ||||||||||||||
| Mailing Address | 263 FARMINGTON AVE FARMINGTON, CT 06030-8031 United States Phone: 860-679-4888 | Fax:860-679-0131 | ||||||||||||||
| Primary Practice Address | 263 FARMINGTON AVE FARMINGTON, CT 06030-0001 United States Phone: 860-679-4888 | Fax:860-679-0131 | ||||||||||||||
| Secondary Practice Address(es) | 2050 KENNY RD 2050 KENNY RD | ||||||||||||||
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