Provider Demographics
NPI:1518024785
Name:HANDY, HEIDI LARAE (LAC)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:LARAE
Last Name:HANDY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9307 CARLTON HILLS BLVD
Mailing Address - Street 2:A
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-2572
Mailing Address - Country:US
Mailing Address - Phone:619-280-7784
Mailing Address - Fax:619-456-2262
Practice Address - Street 1:9307 CARLTON HILLS BLVD
Practice Address - Street 2:A
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-2572
Practice Address - Country:US
Practice Address - Phone:619-280-7784
Practice Address - Fax:619-456-2262
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB1992009416171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist