Healthcare Provider Details

I. General information

NPI: 1124155668
Provider Name (Legal Business Name): HEATHER LEE HAMMOND CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 GROSSMONT CENTER DR PRENATAL CLINIC
LA MESA CA
91942-3019
US

IV. Provider business mailing address

8401 TIO DIEGO PL
LA MESA CA
91941-3925
US

V. Phone/Fax

Practice location:
  • Phone: 619-740-4721
  • Fax:
Mailing address:
  • Phone: 619-303-8623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1529
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: