1245494103 NPI number — MRS. HEATHER LYNN LUEVANO LMFT

Table of content: MRS. HEATHER LYNN LUEVANO LMFT (NPI 1245494103)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245494103 NPI number — MRS. HEATHER LYNN LUEVANO LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUEVANO
Provider First Name:
HEATHER
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
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:
1245494103
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4550 KEARNY VILA RD
Provider Second Line Business Mailing Address:
SUITE 116
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-279-1223
Provider Business Mailing Address Fax Number:
619-516-4757

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2120 THIBODO RD STE 230
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92081-7901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-279-1223
Provider Business Practice Location Address Fax Number:
619-516-4757
Provider Enumeration Date:
07/10/2008

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: 106H00000X , with the licence number:  MFT 42278 , 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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