Provider Demographics
NPI:1376035626
Name:MAVES, HEATHER RENEE (MS)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:RENEE
Last Name:MAVES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2680 SANTA ANA AVE APT B
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-6600
Mailing Address - Country:US
Mailing Address - Phone:805-377-1611
Mailing Address - Fax:
Practice Address - Street 1:2680 SANTA ANA AVE APT B
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-6600
Practice Address - Country:US
Practice Address - Phone:805-377-1611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-02
Last Update Date:2018-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS