Healthcare Provider Details

I. General information

NPI: 1073163960
Provider Name (Legal Business Name): CHLOE HEIT ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2019
Last Update Date: 09/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 N BROADWAY
ESCONDIDO CA
92026-3043
US

IV. Provider business mailing address

PO BOX 235415
ENCINITAS CA
92023-5415
US

V. Phone/Fax

Practice location:
  • Phone: 760-489-4126
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number91549
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: