Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LW0102X | Nurse Practitioner - Women's Health | 269878 | CA |
N | 363LX0001X | Nurse Practitioner - Obstetrics & Gynecology | 269878 | CA |
NPI | 1104021187 |
---|---|
Provider Name | Prof. Alexandra Heitz |
First Address | Blue Jay, CA 92317-2911 |
Second Address | Montclair, CA 91763-2328 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7367 | NURSE PRACTITIONER FURNIS (01) | CA |