Provider Demographics
NPI:1619252913
Name:MCDANIEL, HEATHER LINDSEY (P,A,)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LINDSEY
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:P,A,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:375 ROLLING OAKS DR STE 210
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1028
Practice Address - Country:US
Practice Address - Phone:818-901-6600
Practice Address - Fax:818-997-7826
Is Sole Proprietor?:No
Enumeration Date:2011-10-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21818363A00000X
CAPA 21818363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA 21818OtherPHYSICIAN ASSISTANT LICENSE NUMBER
CAPA 21818OtherPHYSICIAN ASSISTANT LICENSE NUMBER