Healthcare Provider Details

I. General information

NPI: 1871729418
Provider Name (Legal Business Name): HEATHER MARIE D'ADAMO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 07/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10945 LE CONTE AVE STE 2339
LOS ANGELES CA
90095-1687
US

IV. Provider business mailing address

11301 WILSHIRE BLVD MAIL CODE 10H3
LOS ANGELES CA
90073
US

V. Phone/Fax

Practice location:
  • Phone: 917-514-5773
  • Fax:
Mailing address:
  • Phone: 310-478-3711
  • Fax: 310-268-3543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: