Healthcare Provider Details

I. General information

NPI: 1316143050
Provider Name (Legal Business Name): HEIDI A VONDERHEIDE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 03/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7471 N FRESNO ST
FRESNO CA
93720-2457
US

IV. Provider business mailing address

7471 N FRESNO ST
FRESNO CA
93720-2457
US

V. Phone/Fax

Practice location:
  • Phone: 559-436-4500
  • Fax: 559-261-1526
Mailing address:
  • Phone: 559-436-4500
  • Fax: 559-261-1526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA19674
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: