Healthcare Provider Details

I. General information

NPI: 1306603584
Provider Name (Legal Business Name): SANDI HEYER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

957 S VILLAGE OAKS DR
COVINA CA
91724-3696
US

IV. Provider business mailing address

PO BOX 8400
LA VERNE CA
91750-8400
US

V. Phone/Fax

Practice location:
  • Phone: 909-599-8222
  • Fax:
Mailing address:
  • Phone: 626-653-1000
  • Fax:

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: