Provider Demographics
NPI:1609166487
Name:SHUMWAY, HEATHER M (DO)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:SHUMWAY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 N. MAIN ST
Mailing Address - Street 2:DEPARTMENT OF FAMILY MEDICINE
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701
Mailing Address - Country:US
Mailing Address - Phone:714-456-7002
Mailing Address - Fax:
Practice Address - Street 1:5901 EAST SEVENTH ST.
Practice Address - Street 2:VA LONG BEACH
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90822
Practice Address - Country:US
Practice Address - Phone:562-826-8000
Practice Address - Fax:562-826-8000
Is Sole Proprietor?:No
Enumeration Date:2011-04-13
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A12832207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program