Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 20A10617 | CA |
NPI | 1003142886 |
---|---|
Provider Name | Heather Elizabeth Mcdonald |
First Address | San Dimas, CA 91773-4400 |
Second Address | San Dimas, CA 91773-4400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2009 |
Last Update Date | 05/06/2015 |