Provider Demographics
NPI:1023251691
Name:HEIDI'S IMAGE ENHANCEMENT CLINIC
Entity type:Organization
Organization Name:HEIDI'S IMAGE ENHANCEMENT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/ LEA FITTER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:WHITE
Authorized Official - Last Name:OATIS
Authorized Official - Suffix:
Authorized Official - Credentials:CMF
Authorized Official - Phone:510-489-8400
Mailing Address - Street 1:32720 REGENTS BLVD
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-5405
Mailing Address - Country:US
Mailing Address - Phone:510-489-8400
Mailing Address - Fax:
Practice Address - Street 1:2600 CENTRAL AVE
Practice Address - Street 2:SUITE E
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-3187
Practice Address - Country:US
Practice Address - Phone:510-714-8392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAKK316787335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier