Provider Demographics
NPI:1255573234
Name:PATZ, HEATHER TAMARA (PA-C)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:TAMARA
Last Name:PATZ
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 1:2285 CORPORATE CIR
Mailing Address - Street 2:STE 200
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7759
Mailing Address - Country:US
Mailing Address - Phone:702-360-2763
Mailing Address - Fax:949-783-2880
Practice Address - Street 1:4281 KATELLA AVE STE 220
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-6506
Practice Address - Country:US
Practice Address - Phone:562-252-0173
Practice Address - Fax:949-783-2845
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1477363A00000X
CA21565363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L12064Medicare PIN
TX8L12063Medicare PIN