Provider Demographics
NPI:1912967498
Name:HEAL, HEIDI (PA-C)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:HEAL
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 1:370 N. WIGET LANE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2452
Mailing Address - Country:US
Mailing Address - Phone:925-935-0856
Mailing Address - Fax:925-364-5509
Practice Address - Street 1:370 N. WIGET LANE
Practice Address - Street 2:SUITE 210
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2452
Practice Address - Country:US
Practice Address - Phone:925-935-6252
Practice Address - Fax:925-935-7611
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 16677363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant