Healthcare Provider Details

I. General information

NPI: 1982138699
Provider Name (Legal Business Name): HEIDI CHRISTINA MOCK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 LOMITA BLVD SUITE 200
HARBOR CITY CA
90710-2076
US

IV. Provider business mailing address

529 XIMENO AVE
LONG BEACH CA
90814-1730
US

V. Phone/Fax

Practice location:
  • Phone: 310-534-7600
  • Fax:
Mailing address:
  • Phone: 562-243-6104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA164206
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: