Healthcare Provider Details

I. General information

NPI: 1083923478
Provider Name (Legal Business Name): HEATH MCCORMICK MCALLISTER N.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2010
Last Update Date: 02/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11640 SAN VICENTE BLVD STE 103
LOS ANGELES CA
90049-6535
US

IV. Provider business mailing address

11640 SAN VICENTE BLVD STE 103
LOS ANGELES CA
90049-6535
US

V. Phone/Fax

Practice location:
  • Phone: 310-820-7925
  • Fax: 310-820-7949
Mailing address:
  • Phone: 310-820-7925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number10-1205
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: