Healthcare Provider Details

I. General information

NPI: 1245994771
Provider Name (Legal Business Name): HEATHER LYNN CABREDDY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER EDDY

II. Dates (important events)

Enumeration Date: 10/31/2021
Last Update Date: 10/31/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11424 CHAMBERLAINE WAY
ADELANTO CA
92301-2869
US

IV. Provider business mailing address

13320 MISSION ST
OAK HILLS CA
92344-8484
US

V. Phone/Fax

Practice location:
  • Phone: 760-246-0934
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: