Healthcare Provider Details

I. General information

NPI: 1225661663
Provider Name (Legal Business Name): DORIS HEATH NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2020
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26520 CACTUS AVE
MORENO VALLEY CA
92555-3927
US

IV. Provider business mailing address

42304 WILDWOOD LN
MURRIETA CA
92562-3473
US

V. Phone/Fax

Practice location:
  • Phone: 951-486-5189
  • Fax:
Mailing address:
  • Phone: 951-440-2943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95013949
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: