Bruno S Herrera, PHD

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

105676 Issued in CA

Practice address

71817 Highway 111 Ste 1
Rancho Mirage, CA 92270-4487

Phone

(760) 340-5155

NPI assigned

Aug 12, 2015

Last updated

Jul 22, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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

• Cabanas and Lee Dental Corporation

  dba Rancho Mirage Dental Group

  • General Practice Dentistry
  • Rancho Mirage, CA
  • NPI 1083893580
  NPD

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

{
    "created_epoch": "1439337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626912000000",
    "number": "1851767065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7828 DAY CREEK BLVD APT 2-225",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917398569",
            "telephone_number": "919-265-8040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "71817 HIGHWAY 111 STE 1",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922704487",
            "telephone_number": "760-340-5155"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3501F Koury Oral Health Sciences",
            "address_2": "Campus Box #7450",
            "address_purpose": "LOCATION",
            "city": "Chapel Hill",
            "state": "NC",
            "postal_code": "275997450",
            "country_code": "US",
            "telephone_number": "919-265-8040",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HERRERA",
        "first_name": "BRUNO",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-08-12",
        "last_updated": "2021-07-22",
        "certification_date": "2021-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NC",
            "license": "151064",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "MO",
            "license": "202102186",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "105676",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniela Hernandez Banda
• Josephine Rubio Hernandez, LVN
• Linda Guadalupe Hernandez
• Abbie Gail Herndon, OT
• James Datson Herndon, PA-C
• Rodrigo Herreros, M.D.
• Jeffrey Harold Herz, M.D.
• Amy Hetherington, NP
• Michael Jared Hetzel
• Kristen Lynne Hickok, FNP-BC

• Periodontics in Rancho Mirage, CA
• Providers in Rancho Mirage, CA by specialty
• Periodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.