Provider Demographics
NPI:1336173848
Name:HEU, PA (MD)
Entity Type:Individual
Prefix:
First Name:PA
Middle Name:
Last Name:HEU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 VILLA AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612
Mailing Address - Country:US
Mailing Address - Phone:559-353-3953
Mailing Address - Fax:559-261-2610
Practice Address - Street 1:1735 VILLA AVE STE 102
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-2443
Practice Address - Country:US
Practice Address - Phone:559-353-3953
Practice Address - Fax:559-261-2610
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79001207Q00000X
CAA790001207Q00000X
FLME 86385207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H55003Medicare UPIN