Healthcare Provider Details

I. General information

NPI: 1801495171
Provider Name (Legal Business Name): HEATHER ANN SYKORA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2020
Last Update Date: 10/19/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2888 LONG BEACH BLVD STE 400
LONG BEACH CA
90806-1553
US

IV. Provider business mailing address

2888 LONG BEACH BLVD STE 400
LONG BEACH CA
90806-1553
US

V. Phone/Fax

Practice location:
  • Phone: 562-997-8510
  • Fax:
Mailing address:
  • Phone: 562-997-8510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberNP95015070
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: