Provider Demographics
NPI:1821541921
Name:HEATHER R MACDONALD MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:HEATHER R MACDONALD MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:R
Authorized Official - Last Name:MACDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-403-0918
Mailing Address - Street 1:5325 ALTON PKWY STE C715
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-8610
Mailing Address - Country:US
Mailing Address - Phone:949-857-1473
Mailing Address - Fax:
Practice Address - Street 1:16305 SAND CANYON AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3782
Practice Address - Country:US
Practice Address - Phone:949-557-0180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75177208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty