Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | RPS 2005222 | CA |
NPI | 1003921826 |
---|---|
Provider Name | Heather Mercer |
First Address | Redlands, CA 92373-5119 |
Second Address | Banning, CA 92220-6946 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 08/07/2007 |