Provider Demographics
NPI:1568727253
Name:HECK, MILYNDA (LMT)
Entity Type:Individual
Prefix:
First Name:MILYNDA
Middle Name:
Last Name:HECK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31877 PASEO LINDO
Mailing Address - Street 2:
Mailing Address - City:BONSALL
Mailing Address - State:CA
Mailing Address - Zip Code:92003-4903
Mailing Address - Country:US
Mailing Address - Phone:760-807-1957
Mailing Address - Fax:
Practice Address - Street 1:151 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4201
Practice Address - Country:US
Practice Address - Phone:760-807-1957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5662173C00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No173C00000XOther Service ProvidersReflexologistGroup - Multi-Specialty