Provider Demographics
NPI:1831289297
Name:HEIFETZ, SUSAN D (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:D
Last Name:HEIFETZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:DABNEY
Other - Last Name:HOLLANDSWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2067 W VISTA WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083
Mailing Address - Country:US
Mailing Address - Phone:760-726-2180
Mailing Address - Fax:760-726-9928
Practice Address - Street 1:2067 W VISTA WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083
Practice Address - Country:US
Practice Address - Phone:760-726-2180
Practice Address - Fax:760-726-9928
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72895207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine