Healthcare Provider Details

I. General information

NPI: 1730807322
Provider Name (Legal Business Name): MS. ZOE CHRISTINE HECKERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2022
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 MOSS ST
CHULA VISTA CA
91911-2005
US

IV. Provider business mailing address

330 MOSS ST
CHULA VISTA CA
91911-2005
US

V. Phone/Fax

Practice location:
  • Phone: 619-585-4221
  • Fax: 619-585-4680
Mailing address:
  • Phone: 619-585-4221
  • Fax: 619-585-4680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: