Provider Demographics
NPI:1992007389
Name:HEINZE, LORI (PA)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:HEINZE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 S PATTERSON AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-2400
Mailing Address - Country:US
Mailing Address - Phone:805-682-8462
Mailing Address - Fax:805-687-5651
Practice Address - Street 1:334 S PATTERSON AVE STE 205
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-2400
Practice Address - Country:US
Practice Address - Phone:805-682-8462
Practice Address - Fax:805-687-5651
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17297363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant