Provider Demographics
NPI:1114281706
Name:BACALA, HEATHER KAY (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:KAY
Last Name:BACALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6850 N DURANGO DR STE 401
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-4598
Mailing Address - Country:US
Mailing Address - Phone:702-463-2981
Mailing Address - Fax:702-463-2883
Practice Address - Street 1:6850 N DURANGO DR STE 401
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4598
Practice Address - Country:US
Practice Address - Phone:702-463-2981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16589207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1114281706Medicaid
NVV50223Medicare UPIN