Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | G42782 | CA |
NPI | 1063589927 |
---|---|
Provider Name | Lisa E. Heikoff |
First Address | San Diego, CA 92120-2507 |
Second Address | San Diego, CA 92120-2507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 29/11/2021 |