Mibsam Lissette Herrera, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA1491 Issued in FL

Practice address

1811 NE 146TH St
North Miami, FL 33181-1423

Phone

(305) 949-4191

Fax

(305) 949-4833

NPI assigned

Sep 25, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Hantalan Dba Kidz Connection

  • Speech-Language Pathologist
  • North Miami, FL
  • NPI 1871612648
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216771200000",
    "number": "1033306964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1811 NE 146TH ST",
            "city": "NORTH MIAMI",
            "state": "FL",
            "postal_code": "331811423",
            "telephone_number": "305-949-4191",
            "fax_number": "305-949-4833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1811 NE 146TH ST",
            "city": "NORTH MIAMI",
            "state": "FL",
            "postal_code": "331811423",
            "telephone_number": "305-949-4191",
            "fax_number": "305-949-4833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERRERA",
        "first_name": "MIBSAM",
        "middle_name": "LISSETTE",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-09-25",
        "last_updated": "2008-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "PTA1491",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "Y902J",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Deybis Hernandez
• Jose Antonio Hernandez, DC
• Victor Luis Hernandez, RBT
• Larissa Mabel Herrera Herrera
• Daysi Herrera Martinez, LCSW
• Nakiu Alexandra Herretes Marcano, RBT
• Christian Heskestad
• Gerardo Jose Hevilla, MD
• HG Enterprises
• Lucy Hidalgo

• Physical Therapy Assistant in North Miami, FL
• Providers in North Miami, FL by specialty
• Physical Therapy Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.