Provider Demographics
NPI:1609419886
Name:BARTLETT, HEIDI (DAOM, LAC)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:DAOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2554 SWEETWATER DR
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-4708
Mailing Address - Country:US
Mailing Address - Phone:510-345-3505
Mailing Address - Fax:
Practice Address - Street 1:1211 EMBARCADERO
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-5119
Practice Address - Country:US
Practice Address - Phone:510-345-3505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17422171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist