Provider Demographics
NPI:1427200302
Name:ATAMIAN, HEATHER SEVAN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:SEVAN
Last Name:ATAMIAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:HEATHER
Other - Middle Name:SEVAN
Other - Last Name:BROOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2089 6TH ST
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-1161
Mailing Address - Country:US
Mailing Address - Phone:951-283-1087
Mailing Address - Fax:
Practice Address - Street 1:BLDG 201 LEDWARD BARRACKS
Practice Address - Street 2:UNIT 26610
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09244
Practice Address - Country:US
Practice Address - Phone:01149931-804-6669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1082394363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical