Provider Demographics
NPI:1346799640
Name:HELLER PODIATRY LLC
Entity Type:Organization
Organization Name:HELLER PODIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AI-QUOC
Authorized Official - Middle Name:
Authorized Official - Last Name:HELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:702-623-9585
Mailing Address - Street 1:9628 GRAY CAP ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-5826
Mailing Address - Country:US
Mailing Address - Phone:702-623-9585
Mailing Address - Fax:702-586-7308
Practice Address - Street 1:9628 GRAY CAP ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-5826
Practice Address - Country:US
Practice Address - Phone:702-623-9585
Practice Address - Fax:702-586-7308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1205213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty