Provider Demographics
NPI:1992397780
Name:HEIATI, HASHEM (RPH, PHD)
Entity Type:Individual
Prefix:DR
First Name:HASHEM
Middle Name:
Last Name:HEIATI
Suffix:
Gender:M
Credentials:RPH, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13596 PENFIELD PT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-1414
Mailing Address - Country:US
Mailing Address - Phone:858-922-4439
Mailing Address - Fax:760-724-7127
Practice Address - Street 1:1031 E VISTA WAY
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-4606
Practice Address - Country:US
Practice Address - Phone:760-724-7125
Practice Address - Fax:760-724-7127
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52432183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist