Provider Demographics
NPI:1467480251
Name:VANDEWEGHE, HEATHERLY SMITH (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATHERLY
Middle Name:SMITH
Last Name:VANDEWEGHE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10724 LE CONTE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-3112
Mailing Address - Country:US
Mailing Address - Phone:310-968-4313
Mailing Address - Fax:
Practice Address - Street 1:14445 OLIVE VIEW DR
Practice Address - Street 2:DEPARTMENT OF PEDIATRICS
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-1437
Practice Address - Country:US
Practice Address - Phone:818-364-3233
Practice Address - Fax:818-364-3243
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG67145208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics