Provider Demographics
NPI:1619064961
Name:HEPPNER, PIA SANTIAGO (PHD)
Entity Type:Individual
Prefix:DR
First Name:PIA
Middle Name:SANTIAGO
Last Name:HEPPNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:PIA
Other - Middle Name:BANTEGUI
Other - Last Name:SANTIAGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:7665 PALMILLA DR
Mailing Address - Street 2:#5424
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-5090
Mailing Address - Country:US
Mailing Address - Phone:858-552-8585
Mailing Address - Fax:858-642-6442
Practice Address - Street 1:3350 LA JOLLA VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92161-0002
Practice Address - Country:US
Practice Address - Phone:858-552-8585
Practice Address - Fax:858-642-6442
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21173103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)