Healthcare Provider Details

I. General information

NPI: 1750830576
Provider Name (Legal Business Name): HEATHER ESCARENO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2016
Last Update Date: 09/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 G ST
EUREKA CA
95501-1829
US

IV. Provider business mailing address

904 G ST
EUREKA CA
95501-1829
US

V. Phone/Fax

Practice location:
  • Phone: 707-269-2001
  • Fax: 707-269-2044
Mailing address:
  • Phone:
  • 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: