Healthcare Provider Details

I. General information

NPI: 1992702104
Provider Name (Legal Business Name): HEATHER DAWN HAMILTON MS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER DAWN ZEIGLER MS, PA-C

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 05/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10833 LE CONTE AVE
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

5767 W CENTURY BLVD SUITE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-9820
  • Fax:
Mailing address:
  • Phone: 310-825-6078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA202085
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: