Provider Demographics
NPI:1487184610
Name:HERON MEDICAL PLLC
Entity Type:Organization
Organization Name:HERON MEDICAL PLLC
Other - Org Name:AMY DE LA GARZA, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:DE LA GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-910-6189
Mailing Address - Street 1:1941 E PRINCETON AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1824
Mailing Address - Country:US
Mailing Address - Phone:801-910-6189
Mailing Address - Fax:
Practice Address - Street 1:77 S 700 E STE 220
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1162
Practice Address - Country:US
Practice Address - Phone:801-910-6189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10389489261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty