Provider Demographics
NPI:1922257989
Name:TOMILOWITZ, HEATHER (PHD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:TOMILOWITZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11947 VALLEY VIEW ST
Mailing Address - Street 2:#5923
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92846-6500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6 VENTURE
Practice Address - Street 2:SUITE 350
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3340
Practice Address - Country:US
Practice Address - Phone:949-438-3409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24932103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist