Provider Demographics
NPI:1902407158
Name:IRATCABAL, HEIDI KATHERINE
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:KATHERINE
Last Name:IRATCABAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6484 LONTOS DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-6317
Mailing Address - Country:US
Mailing Address - Phone:214-356-4157
Mailing Address - Fax:
Practice Address - Street 1:6484 LONTOS DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-6317
Practice Address - Country:US
Practice Address - Phone:214-356-4157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL511-2848374K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner