Provider Demographics
NPI:1619919941
Name:WASSEF, HEIDI R (MD)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:R
Last Name:WASSEF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-442-8541
Mailing Address - Fax:323-442-8755
Practice Address - Street 1:1500 SAN PABLO ST FL 2
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5313
Practice Address - Country:US
Practice Address - Phone:323-442-8541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG845102085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G845100Medicaid
CA00G845100G56OtherCAL OPTIMA
CA300100925OtherRAIL ROAD MEDICARE
CA00G845100OtherBLUE SHIELD
CAWG84510CMedicare PIN
CA300100925OtherRAIL ROAD MEDICARE
CA00G845100Medicaid
CAWG84510BMedicare PIN
CAWG84510AMedicare PIN
CA00G845100OtherBLUE SHIELD
CAWG84510GMedicare PIN