Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 41265 | CA |
NPI | 1083823843 |
---|---|
Provider Name | Dr. Heidi Lou Kamrath |
First Address | San Diego, CA 92128-2508 |
Second Address | San Diego, CA 92128-2508 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 08/07/2007 |