Provider Demographics
NPI:1033660816
Name:AMADOR, HEATHER
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:AMADOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1434 CIRCLE CITY DR
Mailing Address - Street 2:APT. 101
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-5744
Mailing Address - Country:US
Mailing Address - Phone:951-348-2549
Mailing Address - Fax:
Practice Address - Street 1:1434 CIRCLE CITY DR
Practice Address - Street 2:APT. 101
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-5744
Practice Address - Country:US
Practice Address - Phone:951-348-2549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81391126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARDA81391Medicaid