Provider Demographics
NPI:1942201553
Name:GRADY, HEATHER ALISON (PA-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ALISON
Last Name:GRADY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 VIA LAVENDERA
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-1473
Mailing Address - Country:US
Mailing Address - Phone:949-766-7493
Mailing Address - Fax:
Practice Address - Street 1:26732 CROWN VALLEY PKWY
Practice Address - Street 2:SUITE 351
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6306
Practice Address - Country:US
Practice Address - Phone:949-364-1007
Practice Address - Fax:949-364-0317
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17503363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical