Provider Demographics
NPI:1851644421
Name:ONGBONGAN, HEIDI J (MED)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:J
Last Name:ONGBONGAN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4338 FLAGSHIP CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-5351
Mailing Address - Country:US
Mailing Address - Phone:702-696-0723
Mailing Address - Fax:
Practice Address - Street 1:4955 S DURANGO DR
Practice Address - Street 2:STE. 207
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-0152
Practice Address - Country:US
Practice Address - Phone:702-650-6508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor