Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 14536 | CA |
NPI | 1003441148 |
---|---|
Provider Name | Heather K Mineo |
First Address | Placentia, CA 92870-2844 |
Second Address | Placentia, CA 92870-2844 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2020 |
Last Update Date | 10/03/2020 |