MEDICARE: HEIDY EDELWEISS UMALI

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1629787940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDY EDELWEISS UMALI

Provider Business Mailing Address
First Line	:	1260 N DUTTON AVE STE 230
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95401-7161
Country	:	US
Telephone Number	:	707-525-1515
Fax Number	:

Provider Business Practice Location Address
First Line	:	1260 N DUTTON AVE STE 230
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95401-7161
Country	:	US
Telephone Number	:	707-525-1515
Fax Number	:

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

Provider Enumeration Date	:	11/15/2022
Last Update Date	:	11/15/2022

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Directions to “ HEIDY EDELWEISS UMALI ” Practice Location

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