Healthcare Provider Details

I. General information

NPI: 1982035721
Provider Name (Legal Business Name): HEATHER MALIA SANDISON ND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2013
Last Update Date: 12/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5268 BALTIMORE DR
LA MESA CA
91942-2080
US

IV. Provider business mailing address

2267 MANCHESTER AVE
CARDIFF CA
92007-1939
US

V. Phone/Fax

Practice location:
  • Phone: 619-335-1786
  • Fax:
Mailing address:
  • Phone: 808-342-6271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND618
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: