Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 15815 | CA |
NPI | 1003890773 |
---|---|
Provider Name | Dr. Bea Heller |
First Address | Huntington Beach, CA 92647-1248 |
Second Address | Fountain Valley, CA 92708-3232 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2005 |
Last Update Date | 08/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T 18154 | (02) | CA |