Provider Demographics
NPI:1447898200
Name:PRIETO HERRERA, HILARIO MANUEL (SA-C)
Entity type:Individual
Prefix:
First Name:HILARIO
Middle Name:MANUEL
Last Name:PRIETO HERRERA
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7205 SW 163RD PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-5156
Mailing Address - Country:US
Mailing Address - Phone:786-797-4472
Mailing Address - Fax:
Practice Address - Street 1:7205 SW 163RD PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-5156
Practice Address - Country:US
Practice Address - Phone:786-797-4472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15-173246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty