Provider Demographics
NPI:1457494759
Name:MACIAS, HEATHER LEIGH (ATC)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:LEIGH
Last Name:MACIAS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15030 DOGWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-2735
Mailing Address - Country:US
Mailing Address - Phone:909-606-3541
Mailing Address - Fax:
Practice Address - Street 1:15030 DOGWOOD LN
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-2735
Practice Address - Country:US
Practice Address - Phone:909-606-3541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer