MEDICARE: HEATHER A COLBERT M.D., PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	A79269	CA

General Provider Information

NPI Number	:	1518000546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER A COLBERT M.D., PH.D.

Provider Business Mailing Address
First Line	:	2439 PARKER COURT
Second Line	:
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94043
Country	:	US
Telephone Number	:	650-625-9898
Fax Number	:

Provider Business Practice Location Address
First Line	:	2221 ENBORG LN
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95128-2608
Country	:	US
Telephone Number	:	408-885-6220
Fax Number	:	408-885-3977

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	04/05/2013

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