Provider Demographics
NPI:1700924545
Name:HEARD, CHRISTINE A (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:A
Last Name:HEARD
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 CARLMONT DRIVE
Mailing Address - Street 2:SUITE #4
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-3465
Mailing Address - Country:US
Mailing Address - Phone:650-591-6436
Mailing Address - Fax:650-591-6456
Practice Address - Street 1:2100 CARLMONT DRIVE
Practice Address - Street 2:SUITE #4
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-3465
Practice Address - Country:US
Practice Address - Phone:650-591-6436
Practice Address - Fax:650-591-6456
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3535213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E35351Medicaid
CA000E35351Medicaid
CAZZZ17648ZMedicare ID - Type Unspecified
U20487Medicare UPIN