Healthcare Provider Details

I. General information

NPI: 1841056579
Provider Name (Legal Business Name): HEATHER LEIGH MILES RADT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2024
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47915 OASIS ST
INDIO CA
92201-6950
US

IV. Provider business mailing address

52310 AVENIDA MADERO
LA QUINTA CA
92253-3284
US

V. Phone/Fax

Practice location:
  • Phone: 760-863-8600
  • Fax:
Mailing address:
  • Phone: 206-371-6849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberR1507970523
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: