Healthcare Provider Details

I. General information

NPI: 1437990512
Provider Name (Legal Business Name): HEATHER CHERI POE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24813 NARBONNE AVE APT 103
LOMITA CA
90717-1593
US

IV. Provider business mailing address

24813 NARBONNE AVE APT 103
LOMITA CA
90717-1593
US

V. Phone/Fax

Practice location:
  • Phone: 310-408-3578
  • Fax:
Mailing address:
  • Phone: 310-408-3578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: