1316143050 NPI number — HEIDI A VONDERHEIDE PA-C

Table of content: HEIDI A VONDERHEIDE PA-C (NPI 1316143050)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316143050 NPI number — HEIDI A VONDERHEIDE PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VONDERHEIDE
Provider First Name:
HEIDI
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316143050
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7471 N FRESNO ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93720-2457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-436-4500
Provider Business Mailing Address Fax Number:
559-261-1526

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7471 N FRESNO ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93720-2457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-436-4500
Provider Business Practice Location Address Fax Number:
559-261-1526
Provider Enumeration Date:
06/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  PA19674 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GR0043790 . This is a "MEDICAL ID FOR BAZ ALLERGY ASTHMA & SINUS CENTER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 09029096 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ21572Z . This is a "GROUP PTAN FOR BAZ ALLERGY, ASTHMA & SINUS CENTER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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