1023111093 NPI number — DR. HEIDI MICHELLE ELOWITCH PHD

Table of content: DR. HEIDI MICHELLE ELOWITCH PHD (NPI 1023111093)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023111093 NPI number — DR. HEIDI MICHELLE ELOWITCH PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELOWITCH
Provider First Name:
HEIDI
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TAYLOR
Provider Other First Name:
HEIDI
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023111093
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1238 ALESSANDRO DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWBURY PARK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91320-3503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-732-9446
Provider Business Mailing Address Fax Number:
805-494-0575

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 S WELLS RD
Provider Second Line Business Practice Location Address:
CLINICAS DEL CAMINO REAL INC
Provider Business Practice Location Address City Name:
VENTURA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93004-1302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-732-9446
Provider Business Practice Location Address Fax Number:
805-647-7163
Provider Enumeration Date:
09/06/2006

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: 103T00000X , with the licence number:  PSY29816 , 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)





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