Provider Demographics
NPI:1851436638
Name:DAHL-ROSENBAUM, HEIDI A (MD)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:A
Last Name:DAHL-ROSENBAUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:AVENELLE
Other - Last Name:ROSENBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:530 W OJAI AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-2472
Mailing Address - Country:US
Mailing Address - Phone:805-223-0700
Mailing Address - Fax:
Practice Address - Street 1:530 W OJAI AVE STE 208
Practice Address - Street 2:
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-2472
Practice Address - Country:US
Practice Address - Phone:805-223-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA708662084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry