Individual
JUAN MANUEL HERRERA-GODINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157
(336) 716-2255
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-08059
NC
363A00000X
Physician Assistant
PA156586
OR
363A00000X
Physician Assistant
PA22391
CA
363AM0700X
Medical Physician Assistant
Primary
MED-PAC-LIC-97431
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W18505
MEDICARE
CA
Enumeration date
03/31/2010
Last updated
12/14/2021
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